How to Drink Moderately

As we march into another season of holiday merry making, it’s a good idea to think of some strategies on how not to overdo it, or how to practice moderate drinking. At the core of moderate or mindful drinking is to not become intoxicated or drunk.

You CAN enjoy the initial feelings of relaxation and low buzz and maintain it without losing control and forget that you are drinking and continue to mindlessly consume.

These are some of the suggestions I use with my clients. By no means is the list complete.

Get educated

  1. Know the healthy limits. According to the National Institute of Health moderate-risk drinking looks like this: In one week the maximum number of drinks is 14 for men and 7 for women. Daily limits are 4 drinks for men and 3 for women. This is just one guideline and the numbers fluctuate. But I think the main point is know how much you are consuming daily and weekly. Why not track it? Women can’t drink as much as men (our physiology is different and heavy drinking is more consequential to women—think of reproductive and fertility issues). Long-term heavy drinking causes real physical harm, not to mention an emotional toll.

  2. Know what a “drink” is. A pint is 16 ounces, so it’s slightly larger than a drink.
    Drinks at dinner also count.
    One bottle, 12 ounces of beer (about 5% alcohol).
    5 ounces of wine (about 12% alcohol), about 5 glasses in a bottle.
    One shot or 1.5 ounces of hard liquor (about 40% alcohol).

  3. Understand BAC (BloodAlcohol Content) and think about why it’s important. Maintaining a BAC lower than .06%* is crucial to moderate drinking because our ability to reason becomes impaired at this point. It is the point of no return for problem drinkers. Even if the intention is to limit alcohol intake, if the BAC is higher than .06% you are more likely to continue drinking. Binge drinking is defined as having a BAC of .08% or higher. Binge drinking is having 5 (4 for women) or more drinks in about under two hours.

while drinking

  1. Eat something before getting to the bar or party.

  2. Have a plan.
    How long will you stay?
    Who are you going to be with?
    What time will you be home? .
    Goal is to avoid open-ended nights.

  3. Pace yourself, it’s not a race. Limit yourself to only one drink within a 30-minute period.

  4. Alternate between alcoholic and non-alcoholic drinks.

  5. Drink water in between drinks.

  6. Nosh on snacks while drinking.

  7. Know how alcohol interacts with the medications (over the counter or prescription) you take. Often, medications amplify the effects of alcohol, so let that be the guide in what moderate drinking looks like and not the number of drinks.

Change your mindset

  1. Tell others, friends and acquaintances, of your intention to drink moderately, if you feel they would be supportive.

  2. Ask yourself what is the primary goal of the event? Is it social or just for alcohol consumption? If it’s the latter, rethink who you are hanging out with.

  3. Plan activities that don’t automatically involve alcohol. Be creative.

  4. If you always drink at a certain time, for example after work, have a plan in place for the off nights. Go to the gym, go for a run or plan an outdoor activity. Go to the movies. Avoid falling into a routine of drinking every day.

  5. Remind yourself of the reasons why you want to drink moderately. For example, the hangover next day; money spent on drinks, cabs and food; the pride in knowing that you can practice self control.

  6. Practice mindfulness with alcohol. Is your goal to enjoy the taste of that IPA or red wine? How does it taste? What is its texture? Describe what you observe about your experience of drinking and the people around you.

  7. Notice how alcohol affects people differently. How do you think alcohol affects you?

  8. Write in your journal about the experience.

  9. Remind yourself that it gets easier the more you practice it.

  10. List the benefits of moderate drinking in the same journal.



Let's Review Marijuana

Nearly every day another state or country makes the news as it legalizes marijuana. Here in New York City you can smell it just about everywhere around the clock in the most unexpected places. It's so common, so easy to find, many do not consider it a "drug." Consensus is that it's not bad for you and it’s harmless.

Furthermore, there are scientific and medical studies that claim that marijuana, even when used regularly, is essentially without long-term consequences. Celebrities readily share, endorse, promote and celebrate marijuana. 

But is it really a problem? 

Clients say they enjoy smoking marijuana in the following ways: 

  • Lowers anxiety, promotes a feeling of calm and peace

  • Makes their troubles and worries go away temporarily

  • Helps them sleep

  • It enlivens the senses: movies are funnier, music sounds better, sex feels more intense, food tastes more delicious

  • Life feels less dull

  • They become more imaginative, more creative

  • Helps them connect to a higher level of consciousness

  • One young client even told me that it cures cancer; it doesn't

However, regular smokers of marijuana also admit there are problems. Biggest complaint is that it lowers their cognitive/mental functioning; they can't think clearly immediately after and even hours and days after smoking. 

These are common problems clients experience with regular use: 

  • Memory problems, mostly short-term

  • Low mood: feeling irritable, anxious, more on edge

  • Tiredness, feeling groggy and cloudy

  • Decreased motivation and increased procrastination

  • Feelings of numbness, less inclined to feel happy

  • Coughing and chest congestion

These are what we professionals call withdrawal symptoms. 

And there are more serious problems linked to marijuana. I've met people for whom it triggered a psychotic breakdown even after trying it just once. It's a rare occurrence, but it does happen. For others, they say marijuana makes them anxious, paranoid, and self-conscious. So they stay away from it. 

In my experience, I've learned that for people who already struggle with anxiety and depression regular marijuana use produces unwanted, unpleasant feelings, as it exacerbates pre-existing sensitivities. Clients seek help to cut back or even stop using marijuana because they can’t do it on their own. They recognize that negative effects outweigh the positive and want to feel and function better. Obviously a discussion on abuse, dependence and addiction needs to happen, which I will continue to explore in future posts. If you feel you have a problem with marijuana, first step is to to ask yourself what you are getting from it and what it’s taking away, in other words, look at the pros and cons. Also, ask yourself how does it make you feel?

Drinking in America

When a client comes to me because they are drinking too much, the first thing we do is we evaluate how much and how often they drink. Part of this exploration is to educate the client on health effects of alcohol and to understand the difference between healthy drinking and high-risk or problem drinking. And after the initial screening/evaluation, we then go on to look at other parts of their lives, to see what is contributing to excessive drinking and what the consequences are. This isn't an easy process, but a necessary one.

Often, clients are shocked when they learn that their drinking habit falls into the "problem or high-risk drinking" and, that they often binge drink. What may seem like a typical night out turns out to be a binge drinking session! (For women, binge drinking is drinking 5 or more units of alcohol in one session, and for men it's 7 or more.) For most people, I think, binge drinking is associated with college drinking. But this is not so. *I should note that (three years later in 2018) the definition of binge drinking in terms of number dropped to 4 for women and 5 for men.

Unfortunately, most Americans don't know what problem drinking looks like and dismiss their own heavy drinking until something bad happens. The fact is chronic heavy drinking shortens life and lowers the quality of life.

Here are some facts culled from recent findings about drinking in America.

Bottom line is that alcohol causes far greater harm than drugs By CDC's estimation, between 2006-2010, 88,000 people died annually from complications from alcohol, while 38,329 died from drug overdoses in 2010.

Individually, persistent or chronic problem drinking is associated with depression and anxiety, decline in social and professional functioning (missing work or school, decreased productivity, social isolation, frequent arguing and fighting). Nationally this becomes a $249 billion problem each year in lost productivity and costs to cover treatment and crimes resulting from alcohol. Ultimately we all have to pay.

How We Learn to Self-Medicate

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It is said that in any AA or NA meeting 60% of its group members will have experienced some form of abuse (physical, emotional or sexual) as a child. Childhood abuse is a good indicator of later substance abuse and addiction. 

Recently I posted about ACE (Adverse Childhood Experiences) Study which showed that early adverse experiences, or traumas, predict adult physical and mental health problems that ultimately lead to early death. Adult substance abuse is one such consequence, in addition to smoking and obesity.

In this context, I've been thinking a lot of about validation. To validate simply means recognizing another person's experience of an emotion and their reaction.

If a friend is crying because his dog recently died, I would validate by saying something like "I see that you are really sad" or "You are really missing Buster." In my wanting to help, I might instinctively want to problem solve or advise him so he feels less hurt. I will get there, but first and foremost I acknowledge that his sadness is real and valid.

Imagine a little girl falls and scrapes her knee, and she cries. Her mother or caretaker hopefully will say something like "Oh, no, you fell. Come and let me look at it" or "Let me see. I think it's going to be okay." Both statements indirectly validate that an accident has happened and that the little girl's reaction is valid. But, another parent might simply order the child to stop crying, or say something like "I told you not to run" or "This is what happens when you misbehave by running." 

In a dysfunctional or abusive family, a child's feelings and reactions are invalidated, as the latter examples illustrate. It doesn't seem so bad when looking at just one example, but when it is long-established pattern, parental invalidation teaches the child that her feelings, especially negative ones, can't and shouldn't be felt or expressed. 

The same girl might grow to ignore, disregard, deny or avoid her feelings, especially uncomfortable ones like sadness, anger, shame, guilt, boredom, loneliness, even though they are part of every person's experience.

Enter alcohol and drugs, which in the short-term help her avoid unpleasant feelings. Repeat this way of coping and a dependence and addiction develops. And a cycle of self-medication begins: Immediate relief from unpleasant feelings followed by intensification of those feelings, and so on...




Surviving Mother's Day Without Mother

Depending on your history Mother's Day can be a mere annoyance or day you want to hide out under the covers. Maybe you lost your mother as a child or as an adult, or your relationship with your mother is beyond repair and you are mutually estranged, or you were adopted and you aren't quite sure how you to make sense of your relationship to your mother(s).

Below are some ideas to help you get through the day. Or they may help you alone in the process of mourning or reconciliation.

  1. Acknowledge your feelings When you pause to reflect you may feel many feelings at once, which can be deeply uncomfortable especially if you've never processed your relationship to your mother. You may feel overwhelmed and confused or even conflicted. It's okay. Feelings rise to the surface and they dissipate. Cry if you need to.
  2. Try not to feel resentful
    No doubt you will see families of various configurations on their way to wherever they are going to celebrate. You will encounter displays of love and affection. As difficult as it may be, try your best to feel happy for them. Recognize you are only seeing the surface and it's impossible to know the backstory.
  3. Establish a ritual
    If possible arrange to get together with your siblings, other family members or friends who remember your mother. Or, if you are alone, think back and engage in something that remind you of your mother in a positive way. Did your mother like to eat or cook a particular meal? What was her favorite flower? Was there an activity you did with your mother? If it's not too painful, hold or look at mementos or photos that remind you of your mother.
  4. Connect with your mother
    Write a letter or journal and tell her about how you feel. Tell her you miss her. Tell her something she might be proud of. Dig deep and try to connect and communicate your feelings and thoughts and feelings.
  5. Get spiritual
    If you are religious attend a church service, light a candle, or say a prayer. Read a book or articles about the lasting connection between mothers and children. Death itself is not final. People may cease to exist in this material world but they continue to exist in memories of the living.
  6. Nurture
    Obviously if you are a mother, this is a no-brainer, but for others without children, like Anna Jarvis, explore different options that will allow you to care for and nurture others. If you have a pet, be extra attentive and gentle. It could be simple as watering and tending your plants with extra care or maybe you will decide to volunteer to give a part of yourself to others in need.
  7. Self care If you find yourself feeling sad, empty or lonely, or just plain confused, avoid activities that numb or tune you out from the world and yourself. Self-numbing behaviors can include drinking excessively, using drugs, compulsively surfing the internet or binge watching anything. At its base, self care is recognizing that you operate as a system. And systems require regular maintenance for it to operate optimally. Be sure to get enough sleep, feed yourself regularly, move your body, and connect with nature or whatever you do to feel grounded and solid. Ask yourself what how would your mother take care of you? And, if you were a mother how would you care for your child?
  8. Distract
    If you lost your mother or broke off with your mother recently and your feelings are too raw, it may be tempting to ruminate or dwell on grief, anger, disappointment, regret, or some combination of difficult feelings. Try to plan ahead and schedule activities, and write them down. Putting them on paper will make it more likely that you will follow through with your plans. 

History of Mother's Day Ironically the woman responsible for making Mother's Day a national holiday never married nor had children of her own. To honor the memory of her own mother Anna Jarvis made it her project to make Mother's Day a national holiday. Her dedication finaly paid off in 1914 when president Woodrow Wilson declared second Sunday of May as Mother's Day. Not long after, however, Jarvis became disillusioned by its co-optation by commercial interests (florists, card companies, department stores) and she unsuccessfully tried to take Mother's Day off the national calendar.

Child Adverse Experices (ACE) and Adult Health

Federal law defines child abuse as the following:
  • "Any recent act or failure to act on the part of a parent or caretaker which results in death, serious physical or emotional harm, sexual abuse or exploitation"; or
  • "An act or failure to act which presents an imminent risk of serious harm."
Number of reported cases of child abuse is about 3 million annually. Every ten seconds another case of child abuse is reported to child protective services. 

I can't help wonder the actual number of children affected by child abuse and neglect. In my private practice and my work at a community mental health clinic, vast majority of clients experienced some form of abuse and neglect as children, but most of these cases did not get reported.

So, why do my clients come to therapy? Main complaints are: depression, anxiety, problems with drug and alcohol, addiction to food or sex, relational problems, sleep issues, low self confidence, general dissatisfaction in life. 

The relationship between childhood trauma and its effect on adult physical and mental health has been measured and documented in a study with over 17,000 people: ACE Study (Adverse Child Experiences). You can measure your score here. 

I will definitely revisit this subject in future posts.

Dangers of Binge Drinking

Have you drunk more than 8 drinks in a single occasion this month? If you answer is yes you are not alone. On average 38 million American adults binge 8 or more drinks at a rate of 4 times a month.

I've written about binge drinking and its dangers before. One of the biggest misconception about binge drinking is that it's a problem primarily for young people — minors, college students and young professionals. What may surprise you is that the group of people who are at most risk from dangers of binge drinking (defined as drinking 5 or more drinks in one occasion) are middle aged adults.

According to the latest report from the CDC, 6 people on average die from alcohol poisoning each day. Surprisingly, 75% of them are adults between 35 to 64 years old. And majority of them (75%) are men.

Clients I see will NOT die from alcohol poisoning. The problem as I see it is that frequent binge drinking or heavy drinking normalizes drinking until it becomes habitual. It becomes the norm. Without so much awareness habitual drinking becomes the way to deal with unwanted feelings and positive feelings. Prolonged alcohol abuse weakens all the systems in the body and contribute to unnecessary health conditions, lower our quality of life and contribute to early death.

It's difficult to believe but alcohol-related deaths outnumber all drug overdose deaths each year.

In our culture we celebrate, socialize and cope with stress with alcohol. Inherently this isn't a bad thing. As long as we have inhabited this planet, we have invented concoctions to help us escape reality.

What is "bad" is when alcohol use or overuse becomes the "go to" to deal with stress, anxiety, loneliness and boredom.

If you find yourself drinking habitually ask yourself these questions.

• Am I drinking too much? (Everyone has that inner voice of reason, which is often more ignorable under the influence)
• Do my friends or social circle drink too much and act up in ways that raise red flags (DUI's fights, arrests, questionable sexual behavior?
• Do I wake up middle of the night and find myself unable to fall back asleep?
• Am I hungover in the morning and have a hard time getting going?
• Am I missing school or work because of my drinking?
• Have others (friends, family, partner, husband or wife) nagged me about my drinking?

Binge Drinking

Dictionary definition of binge:
a : a drunken revel
b : an unrestrained and often excessive indulgence
c : an act of excessive or compulsive consumption (as of food)
Binge drinking is defined as drinking five or more drinks in one sitting or session. If you want to get technical it's five for males and four for women. Women, due to size and biology just can't handle as much alcohol. Excessive or heavy drinking cutoff is more than 15 drinks per week for men and 8 for women. Just to get really nerdy, a drink is equivalent to a 12 ounce bottle or can of beer (this means a pint is a drink and a half), a shot of liquor and 5 ounces of wine (five units in a bottle).

Why is binging on alcohol so bad for you?
• You will feel bad the next day. Hello hangover!
• Increased likelihood of injury from falls, trips, bumping into things
• Under the influence (drunk) you are more likely to be disinhibited: doing things you normally wouldn't, like having unprotected sex, deciding to drive home, spending money excessively, etc.
• Alcohol poisoning which can permanently damage your brain, liver and other organs
• Getting into fights with friends, strangers, or your significant other
• Getting arrested, going to jail, etc.
• It may become habitual, which means you are at risk of becoming alcohol dependent and early death

According to the CDC, one in six adults binge drink about 8 drinks 4 times a month! 


How to Beat the Holiday Blues

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Thanksgiving is the first of the triple threat (Christmas and New Year's complete the trifecta) that can make you sing the holiday blues... If you are like me making "happy happy" during this time can actually be a real downer. If there are family conflicts (who doesn't?) the obligatory joy and gladness can seem like one big fat cruel joke. In addition, if you are struggling with relationships, work, money or going through a significant life-changing event (breakup, divorce, death of a loved one) you feel you want to skip the festivities. However, non-participation may not be an option. And for others the possibility of spending any of these holiday without family and friends can them into a dark and lonely place.

Here are some tips for avoiding emotional fallout this holiday season. 

1. Recognize physical symptoms of depression and anxiety. Emotional distress begins in the body. If you feel exhausted and tired look inward to see if it's psychological or physical. Anxiety can manifest as stomach upset, insomnia, irritability or jumpiness. Again, take an inventory. Identifying and understanding physical symptoms is the first step in addressing them. Whether the source is emotional or physical, you can do something about them.

2. Ask yourself what the symptoms mean. If they are physical, slow down, rest, change your diet etc... If they are psychological in origin ask yourself what are these feelings and what do they mean? Are you trying to suppress or ignore feelings of guilt, obligation, resentment and anger, or any other negative emotion?

3. Be kind to yourself and others. If you don't feel well and cranky maybe going to a holiday party isn't the best idea as it may make you feel worse. Sitting out a party or a gathering can be the kinder thing for yourself and for others; you are sparing negative energy from people you love and like. Listen to your inner voice even if it's saying something out of the ordinary.

4. Talk it out with your therapist, friends and family (not at the party or the dinner). Engage, reach out and share your feelings. If other people aren't available, talk to yourself by writing it out in a journal.

5. Go easy with food and drink. Alcohol will certainly amplify whatever you are feeling and overindulging will actually worsen symptoms of anxiety and depression and decrease the quality of sleep. As for food, gaining extra weight is much easier and more fun than losing it, so practice moderation.

6. Get your sleep and exercise. Enough said.

7. Be proactive. If you know you are going to be alone research and plan ahead activities. Do you have books, movies and activities to keep you occupied? Reach out to others who may be also be in the same boat.

8. Lower your expectations, or at least make realistic your expectations of the holiday season. Norman Rockwell's version of American holiday experience is aspirational at best. 

9. Create your own rituals even if it's just for this year. Maybe Santa Claus will no longer be welcomed in your home. Rather than receiving maybe Christmas is just about giving nonmaterial things. Go ahead and create your own activities based on YOUR values.

10. Be mindful. Holidays come around once a year and for some it is a season of fun and celebration. Acknowledge their right as your own. Also, be mindful that, thank god, they come around just once a year and this too shall pass. 

16 Danger Signs of Relapse

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This list is from an excellent Facebook post. Even though the list seems it's from AA (Alcoholics Anonymous) for AA members, I think we can all benefit from this list even if we are not struggling with a severe addiction. I feel addicted can also mean we compulsively repeat certain patterns of behavior based on a set of beliefs, which can hold us back from growth.

For those of you who say you are "allergic" to the AA model,  go ahead and read the list and replace AA, sponsor, meetings with family, friend, get together, etc...

Relapse can mean returning to an old behavior which you attempted to change or correct. Or it can mean actual addiction to alcohol and drugs.

Basically, be present and be mindful of what's going on in yourself.

DANGER SIGNS OF RELAPSE

1. Exhaustion — Allowing oneself to become overly tired; usually associated with work addiction as an excuse for not facing personal frustrations.

2. Dishonesty — Begins with pattern of little lies; escalated to self-delusion and making excuses for not doing what's called for.

3. Impatience — I want what I want NOW. Others aren't doing what I think they should or living the way I know is right. Instant gratification is a monster that needs to be tamed.

4. Argumentativeness — No point is too small or insignificant not to be debated to the point of anger and submission.

5. Depression  — All unreasonable, unaccountable despair should be exposed and discussed, not repressed: what is the "exact nature" of those feelings?

6. Frustration  — Controlled anger/resentment when things don't go according to our plans. Lack of acceptance. See #3. Being a baby.

7. Self-pity — Feeling victimized, put-upon, used, unappreciated, disrespected: convinced we are being singled out for bad luck.

8. Cockiness — Got it made. Know all there is to know. Can go anywhere, including frequent visits just to hang-out at bars, boozy parties or an other potentially complicated setting where the addiction monster may get tempted.

9. Complacency - Like #8, no longer sees value of daily program, meetings, contact with other(s) alcoholics, (especially sponsor!), feels healthy, on top of the world, things are going well. Heck may even be cured!

10. Expecting too much of others — Why can't they read my mind? I've changed, what's holding them up? If they just do what I know is best for them? Leads to feeling misunderstood, unappreciated. See #6.

11. Letting up on disciplines — Allowing established habits of recovery - meditations, prayer, spiritual reading, emotional support system or AA contact, daily inventory, meetings or getting together with a pal — to slip out of our routines; allowing recovery to get boring and no longer stimulating for growth. Why bother?!

12. Using mood-altering chemicals — May have a valid medical reason, but misused to help avoid the real problems of impending alcoholic, drug or a behavioral addiction relapse.

13. Wanting too much — Setting unrealistic goals: not providing for short-term successes; placing too much value on material success, not enough on value of spiritual growth.

14. Forgetting gratitude — Because of several listed above, may lose sight of the abundant blessings in our everyday lives: too focused on # 13.

15. "It can't happen to me." — Feeling immune; forgetting what we know about the disease of addiction, including alcoholism and its progressive nature.

16. Omnipotence — A combination of several attitudes listed above; leads to ignoring danger signs, disregarding warnings and advice from fellow members or emotional support network.

Swedish Therapy Cabs: Therapy on the Go

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Sweden has the highest number of one-person households in the EU — 47% of Swedish households are comprised of persons living alone. Living alone can increase loneliness and other symptoms of depression especially during long Swedish winters where there is very little daylight.

In an attempt to introduce therapy to riders who may be experiencing depression and/or other issues, Taxi Stockholm, a private taxi service, has hired three therapists to provide counseling in the back seat of its taxis to passengers. The idea is to normalize therapy and even help passenger/client with a pressing issue. No matter how short the ride, bringing therapy to the rider can expose and normalize the idea of therapy so they are more likely to seek it out themselves after they leave the taxi.

What a great idea! I am all for it — especially in large cities where personal connections are difficult to make and maintain and time is short. This could be one very clever idea to destigmatize therapy for the general public.

Watch Now! Russell Brand: From Addiction to Recovery



Russell Brand is one celebrity who is pretty cool. This isn't the first time I've written about him. I can respect him because he uses his fame to bring attention to the problem of addiction and benefits of meditation and yoga.

So I was happy to discover that after Amy Winehouse’s death from alcohol withdrawal, Brand made a short documentary with BBC about addiction and recovery. And The Guardian published a moving eulogy he wrote for her.

Discovering this short doc (about an hour long) several years late does not diminish its significance. Brand discusses with experts about opiate replacement therapy. At times, he can be overbearing and appears fixated on his recovery process. However, Brand’s narcissism is tolerable, because he argues that for addicts like himself it's abstinence or death.

He argues against methadone saying it’s an opiate replacing heroin, which means that the addict is not drug free, and an addict wiI am certain he would criticize Suboxone since it too is a synthetic opiate prescribed to curb cravings and withdrawal symptoms, just like methadone. The difference is that Suboxone is prescribed by a psychiatrist, as opposed to daily pick ups at a methadone clinic, so it no longer carries the stigma of having to drop in every morning at your local MMTP (Methadone Maintenance Treatment Program).

An addict, Brand stresses, must be free of all drugs, although whether he includes psychotropic medications, it’s unclear. Both AA and NA agree with Brand; and they consider prescription medications as drugs. Therefore, an AA member who is prescribed medication, for say depression and anxiety, is not drug free or abstinent. I find problem with this, because so many people struggling with substance abuse suffer from underlying mental illness. 

What are your thoughts?

Newest Eating Disorder: Orthorexia

http://www.choosingraw.com/neda-week-2014-considering-orthorexia/
Do you or do you know someone who adheres to a self-imposed dietary restriction that make going out for a simple meal a major headache? Do they sometimes go to the extreme of not eating because the food doesn't pass the "clean" test? Does a simple trip to the supermarket turn into a time consuming and stressful event during which every label must be carefully studied?

We all know vegetarians, rawfood enthusiasts, glutenphobics, pescartarians, freegans or just picky eaters. When does health consciousness become pathological? When does it become an eating disorder?

Eating disorders is primarily a problem of the West though it might be more accurate to say it's a problem in wealthier countries. In no way do I want to minimize the seriousness of eating disorders, a serious medical and mental health issue. But the fact that one in nine people in the world do not consume enough food to sustain a healthy life makes this disease especially poignant. Having an abundance of choices sometimes can be problematic.

Eating disorders (anorexia nervosa and bulimia) can cause amenorrhea, damage to the teeth, and in extreme cases it can even cause death. 

So what exactly is orthorexia? Ortho (straight, rectangular, upright, as in orthodontics and orthopedics) + orexia (desire, appetite). Anorexia = loss of appetite or lack of desire for food. Orthorexia: rigid appetite.

Orthorexia has not been recognized by the DSM, so it is not an official diagnosis, yet. Professionals in the field define orthorexia pathological desire to eat healthily, so much that it interferes with a "normal" life and jeopardizes physical health.
Experts say orthorexia becomes life-threatening when people's food restrictions make it impossible for them to take in enough calories and nutrients to maintain good health. Bell recently treated a 14-year-old girl who ate only raw fruits and vegetables. She dropped to 80 pounds and had to be hospitalized for an irregular heartbeat.
Orthorexia is one example of a healthy enthusiasm that becomes an addictive behavior creating harm and decreasing one's quality of life.

Economics of Drinking

Pareto Law is a little known principle applicable to multiple disciplines. It is better known as the 80-20 rule: 80% of the effects comes from 20% of causes, or 20% of workers in an organization perform 80% of the work. 

 What does this have to do with alcohol consumption? Everything, of course. 20% of Americans consume 80% of alcohol sold in the U.S. 

 Check out this graphic.

Shockingly, 10% of Americans (24 million people over the age of 18) drink over 50% of all alcohol consumed in America. That averages out to 10 drinks per day or nearly 74 drinks a week (2 bottles of wine a day, or 18 bottles of wine or three 24-cases of beer per week).

 These statistics are from Paying the Tab: The Costs and Benefits of Alcohol Control by Philip Cook, a professor of Public Policy at Duke. And, I have not read the book yet.

 Here are some more fascinating bits from the book which used data from a national survey that took place between 2001 and 2005: 
  • 30% of Americans don't drink at all. 
  • 30% of Americans drink at least one drink a day 
  • 20% drink at least two a day. (BTW, low-risk or moderate drinking falls somewhere between the two.) 
And according to the CDC excessive drinking costs us $223.5 billion in 2006, or about $1.90
per drink.

Definitely more to come on this fascinating topic...


All About Alcohol

Contrary to what we are led to believe, alcohol is the worst when it comes to harmful consequences. Globally it kills 2.5 million people and nationally 75,000 people die prematurely because of alcoholism and alcohol-related illnesses. It is the third leading killer globally.

An infographic from the team at Addiction Blog
Alcohol and the modern world (INFOGRAPHIC)

Here are some sobering facts about alcohol you may not have considered:

What is heavy drinking or risky drinking?
For men 14 or more units of alcohol per week.
For women, the number drops to 7.

What is a unit of alcohol?
.6 fluid ounce or 12 grams of pure alcohol, that is a 12 oz. bottle of beer, a shot of booze or a glass of wine (1/5th of a bottle).

Prolonged alcohol abuse or heavy drinking is linked to serious health risks:
  • alcoholic cardiomyopathy 
  • alcoholic liver disease 
  • decrease in bone density 
  • decrease in bone mass (leading to osteoporosis) 
  • heart arrythmias 
  • increased blood pressure 
  • increased risk of bone fracture 
  • loss of immune response 
  • stroke
But, just being drunk can be bad in the short term.
Lest we forget: alcohol costs money, it has calories, and it speeds up the ageing process.

Russell Brand on Spiritual Practice


I don't know about you but Russell Brand is difficult to ignore. He has certainly made most intimate aspects of his life public: short lived marriage to a pop star; addiction to drugs and alcohol followed by recovery. He has made a name for himself as a passionate advocate of yoga and meditation. I respect him for making statements on subjects that make people and corporations very uncomfortable. But let's not forget he is a comedian and it's their job to make us feel hot under the collar, but he does a particularly great job at it.

I am featuring the short video above, actually a compilation of clips, which showcase his view on spirituality, addiction, culture, etc... And I have to say I like what he says and how he says it. The intensity of the delivery reveals the zeal with which he once consumed alcohol, drugs and sex. It is to our benefit that he has found another outlet to sublimate or redirect his energy. And so is he. In fact, as any addict in recovery will tell you, he probably wouldn't be alive to tell it how it really is.

One more thing, addiction takes time, energy, money and effort. Which begs the question, what are you going to do instead of abusing alcohol and drugs? How are you going to fill the time which was once devoted to getting high and drunk? For many, as is the case for Mr. Brand, a spiritual practice fills that void.


Anxiety in Choosing

Whether you are looking to purchase your first home, choosing an outfit for that first date or job interview, or deciding to marry or move-in together with your boyfriend or girlfriend, making decisions can be a harrowing process.

If the decision involves a lot of money it will raise all sorts of associated worries. Do I have enough money? Will I have to cut back on something else to cover the investment? If something goes wrong what will happen to my future? Will I become homeless or need to work two jobs?

If you need to decide the fate of a romantic relationship, anxieties in the form of ambivalence may rise. You can love and feel affection for someone while secretly harboring concerns about them: Will they become financially and emotionally dependent on me? Will their quirks become full-blown craziness down the road? What sort of parents are they going to become? Will they become their parents?

Ambivalence is the experience of feeling two opposing emotions simultaneously. The ambivalent partner may feel weighed down by guilt and confusion: If I really loved this person I shouldn't be feeling this way... so the thought goes. But is there anything in life that is wholly black and white?

The fact is we are constantly choosing. We make decisions each and every moment. We don't notice because for the most part these decisions are miniscule and inconsequential: a poorly thought-out outfit probably isn't going to affect your future too much. Also, when we make the same decision repeatedly (mindlessly, without thinking) we forget we are choosing.

One aspect of being a mature human being is that inevitably we have to make a big decision that will affect the rest of our lives. The option to not choose is really not an option (remember Bartleby the Scrivener?).  The other option is to live off the grid and live independently, freed from social conventions and modern amenities.

Here is a very good piece of marketing — profound and entertaining at the same time!



More on decisions and decision-making process later.

P.S. I condone moderate drinking, as does Jim Beam and Willem Dafoe, I am sure.



David Foster Wallace on Meaning of Life or How to Think

Waking up on this beautiful spring morning I wanted to share this with my readers (and my clients). Listen for his emphasis on "the default settings" of the self, which "make us automatically think that we are the center of the world." Becoming aware, or tending to our awareness is the escape key from this default setting. Sounds like mindfulness practice to me.

 I also love how he defines true freedom: ". . . attention, and awareness, and discipline and being able truly to care about other people and sacrifice for them over and over, in myriad, heady little unsexy ways. That is real freedom."

 This is just one part of the talk, for the other half please follow the link.
Here is a meaty quote to ponder from the commencement speech delivered at Kenyon college in 2005.

"If you worship money and things — if they are where you tap real meaning in life — then you will never have enough. Never feel you have enough. It’s the truth. Worship your own body and beauty and sexual allure and you will always feel ugly, and when time and age start showing, you will die a million deaths before they finally plant you. On one level, we all know this stuff already — it’s been codified as myths, proverbs, clichés, bromides, epigrams, parables: the skeleton of every great story. The trick is keeping the truth up-front in daily consciousness. Worship power — you will feel weak and afraid, and you will need ever more power over others to keep the fear at bay. Worship your intellect, being seen as smart — you will end up feeling stupid, a fraud, always on the verge of being found out. And so on."
I can't close a piece on DFW without mentioning his suicide. I don't have much to say at present other than again raise the connection between creative people and mental illness. BTW, one piece of fact I do know is that he hung himself as he was trying to wean off psychiatric medications he had been taking for many years for depression.

FYI: April Is the Cruelst Month and Child Abuse Prevention Month


I. THE BURIAL OF THE DEAD

APRIL is the cruellest month, breeding
Lilacs out of the dead land, mixing
Memory and desire, stirring
Dull roots with spring rain.

excerpt from T.S. Eliot's The Waste Land


Yes, in case you didn't hear, April is child abuse prevention month. The connection between the poem and government-sponsored, PSA-worthy month which goes unnoticed is beyond tenuous. But child abuse is cruel as it makes lasting negative impact for the rest of that child's life, I make no apologies for quoting T.S. Eliot.

As a social worker I am a mandated reporter, which means by state law I have to report to ACS (Administration for Children's Services) suspected cases of child physical, neglect or sexual abuse. Teachers, doctors, psychologists, nurses, police, EMS are also mandated reporters. I am sure I am forgetting a few professions.

Physical and sexual abuse is easy to define and comprehensible by non-professionals. Neglect, however, is a bit more difficult to define. It can mean abandonment — leaving children under the age of 12 unattended, using drugs around minors (cannabis excluded), not having food in the home, children missing school and providing inadequate medical care. Since I am listing them from memory I am sure it's incomplete. Child neglect/emotional abuse is difficult to assess, but it can damage just as much as other forms of abuse.

Working with children can be one of the most rewarding/heart-breaking experiences. Most children end up in therapy due to "benign neglect; their parents (in my case single mothers) simply lack the energy (depression, poverty) or their attention have been compromised by their own needs (boyfriend, job) to be fully emotionally present with their kids (or to provide good-enough parenting). But children are amazingly resilient, and like the way plants forgotten in the corner become revitalized with regular watering and sunlight, children respond to undivided attention and adult presence.

On a couple of occasions, children who were actively being abused were put under my watch. And making that report was heart wrenching knowing what I know about the overburdened system. It felt like I was handing a child over to a barely functioning bureaucracy with my fingers crossed, hoping their welfare didn't deteriorate.

For a brief overview on the lasting impact of childhood trauma, go here.




NCA PSA 2013 "Stand Up, Step Forward" from Ian Buchanan on Vimeo.

Importance of Sleep

http://www.animal-ethics.org/sentience-section/

Whenever I see a new client, I always review their sleep pattern. Quality and length of sleep is indicative of general mental health. Inability to have a good night's rest indicates anxiety, which tends to be a close companion of depression. Depression can make one sleep too much or too little; and it can make one eat too little or too much. (Here is a very moving talk on depression.)

Below is a small set of questions I ask my clients at the start of therapy and periodically thereafter to monitor their overall mental health.
  • Are you able to fall asleep within a reasonable amount of time?
  • Are you able sleep through the night or do you wake up in the middle of the night and find yourself unable to fall back to sleep?
  • Do you require alcohol or other depressants like marijuana to become "sleepy"?
  • Do you wake up early morning but not able fall back asleep right away, only to fall asleep after a period and then wake up later than planned?
  • Do disturbing dreams or nightmares regularly wake you up?
  • Do you regularly get less than 6 hours of sleep a night?
  • Do you "catch up" on the weekends?
  • Do you experience sleep apnea?
Most adults require at minimum 6 hours and at optimum 8 hours of sleep a night. Younger adults require more sleep than older people. It's a myth that you can catch up on sleep. What's actually happening is that your body is resting for a longer period than normal, but sleep itself cannot be made up.

Here are some suggestions to help you re-regulate your sleep to a more healthier routine to help you feel recharged.
  • Make the room as dark as possible. An eye mask can do the trick, as well as ear plugs.
  • A cooler room is better for sleeping. We all know how it's hard it is to sleep in the middle of a heat wave.
  • Remove or cover your clock, or smartphone. Being conscious of time can worsen insomnia. Being a clock watcher during the night can increase anxiety. Even a small amount of light from an alarm clock can affect the production of melatonin, an enzyme released by the pineal gland in the brain that regulates your circadian rhythm, or your natural sleep cycle.
  • Keep the bedroom for sleeping, or for sex: Don’t work, use your computer or watch TV in bed, at least not right before going to sleep. (Personally, reading in bed during an off day is one of the greatest luxuries.)
  • Stay away from all electronic devices before sleep. We all know why. 
  • Stick to a routine: Human bodies work better on a schedule, so try and unwind an hour or two before bed and go to sleep at around the same time each night. We get our best sleep between 10 p.m. and 1 a.m., so don’t stay up late.
  • Have a spoonful of honey before bedtime. 
  • From Tim Ferris: Eat a small snack of celery with almond or peanut butter. He will give you scientific reasons why it works, along with other super high-tech, downright odd hints about getting optimum sleep.
  • Take a hot bath or shower. (Tim Ferris suggests a cold bath before bed.) Lavender oil in the water and on your temples will help you relax.
  • Journaling before sleep will help you clear your mind and set the agenda for the next day. My suggestions to clients: What 3 things went right today? Or, you can write in a gratitude journal. 
  • Make a list for the morning, important things that need your attention right away. If you are anxious about something you have to wake up for, make a check off list and check off everything on that list, so your mind can shut off.
Before reaching for Tylenol PM, or asking your doctor for Ambien or another prescription sleeping pill, try chamomile tea with honey, valerian tea with lots of honey (valerian stinks but is a mild sedative), or melatonin (essential for business travelers). Melatonin is available at drug stores and is a nutritional supplement.

One of the greatest sleep aid is strenuous exercise like running. In addition to promoting good sleep, great skin turns out to be another benefit from running.