Learning about alcohol and drugs.

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Drugs.

Drugs.
Photo courtesy of Pixabay.

How much do you really know about alcohol and drugs?

Despite the prevalence of drugs and alcohol in our society, many people have never had any formal education about drugs or alcohol. Most people get their education in this area the same way they learn about sex, on the street, and by experimentation.

As a society, we have a love-hate relationship with drugs and alcohol. The consensus seems to be that drinking and doing drugs can be enjoyable, but that “losing control” of that habit can be harmful maybe even deadly. Clearly simplistic solutions, just say no, or saying only bad people have problems is not working.

Ignoring the effects of addiction and alcoholism is easy.

Most people try to ignore the problem until it overwhelms them personally, or someone close to them. It’s reassuring to believe that addiction or alcoholism is something that happens to “those kinds of people,” the weak, or the lazy.

Not everyone who experiments with drugs or alcohol develops a problem. We know that young people are likely to try new and exciting experiences. Initially, it all sounds like fun. Most go on to have typical lives. But increasingly we are seeing people of all ages, including the older generation, whose lives are being damaged by substances.

Most people’s conception of an alcoholic is the homeless bum on the street, someone who can’t work and drinks all day every day. The unpleasant truth is that 95% of all alcoholics have full-time jobs. It’s entirely possible that you meet these hidden alcoholics every day. For every person with a drinking problem, estimates tell us that, 5 to 8 other people are harmed by that person’s drinking.

In some hospitals, half of the bed are taken up by people whose illness is primarily caused by or made worse by the direct results of alcoholism.

The problems with alcoholism and addiction are all around us.

In every city in America of any size, and I feel confident this happens everywhere else on planet Earth, we see the harm caused by the misuse of substances. A quick look at last night’s paper shows several people arrested for DUI. Several accidents in which one or both drivers were intoxicated. And an occasional story about someone dying of a drug overdose.

The war on drugs misled us.

American’s have noticed a staggering increase in the number of people who are dying from overdoses of prescribed opiate drugs. Despite a long-running war on drugs, the devastation is worse now than it was before. Several unpleasant facts emerge from studying substances and substance use disorders.

The majority of drug overdose deaths arise from prescribed medications, not street drugs.

Legal or tolerated drugs, nicotine, and alcohol each kill more people per year than all the illegal street drugs combined. Most of the deaths from drug overdoses involve people who have more than one drug in their bloodstream. Mixing alcohol with other drugs, prescription or street drugs, increases the risk of death.

Many professionals lack education about the effects of drugs and alcohol.

Most professionals working in the mental health field have minimal training in substance-related problems. Most counselors and therapists receive from one to three units in substance-related classes in an entire master’s program. Surveys indicate that the majority of people with substance use disorder, 60% or more, also have a co-occurring disorder. Furthermore, many people with diagnosed mental illness, approximately 50%, also have a substance use disorder.

In my own experience, it is extremely common to find someone with severe depression or high anxiety, who is also abusing substances. Use of alcohol or drugs may temporarily mask symptoms but in the long run, using substances as a crutch makes the problem worse.

Therapists who work with couples often find that one or both parties are using drugs or alcohol, and this is contributing to the marital discord. Unfortunately, many counselors who were not trained in substance use disorders ignore the problem rather than ask about it.

Since I started in the counseling field as a substance use disorder counselor, I’m acutely aware of how commonly mental health problems and alcoholism or addiction occur together. Substance abuse counselors, at least here in California, typically go through a 36-unit program with many of the classes specifically focused on alcohol, drugs, and the process of moving from use to addiction.

Very soon school will be back in session, and this semester I will be teaching several classes in the substance use disorder program. While I don’t want to shift the counselorsoapbox.com blog specifically towards drugs and addiction, I thought it might be useful to share with you some of the material I use in my substance abuse counseling classes. Also, in the near future, I am planning to release some of this material as videos on our very own counselorssoapbox YouTube channel. Stay tuned, and I will let you know how the videos are progressing.

If you made it this far, thanks for reading, and please remember to click like if you enjoyed this post and please leave comments. Talk to you again soon.

Staying connected with David Joel Miller

Three David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

SasquatchWandering through a hole in time, they encounter Sasquatch. Can they survive? The guests had come to Meditation Mountain to find themselves. Trapped in the Menhirs during a sudden desert storm, two guests move through a porthole in time and encounter long extinct monsters. They want to get back to their own time, but the Sasquatch intends to kill them.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Books are now available on Amazon, Kobo, iBooks, Barnes & Noble, Google Play, and many other online stores.

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For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

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Obsessive-Compulsive and Related Disorders.

By David Joel Miller.

Obsessive-Compulsive Related Disorders.

Obsessive-Compulsive and Related Disorders.
Photo courtesy of Pixabay.com

Obsessive-compulsive is a label that is frequently misused. Most people, when they say they are obsessive-compulsive, mean that they have strong preferences for the way they want the thing to be done. In the mental health field, what we mean by Obsessive-Compulsive Related Disorders are a group of disorders which seriously interfere with a person’s relationships, their ability to work, cause them distress, or prevent them from engaging in other important activities.

A personal story about compulsions to illustrate this difference.

I have a preferred breakfast meal. It comes frozen and is relatively inexpensive. Each week when I do the grocery shopping, I buy enough for the following week. I tend to eat this meal every day. Should I end up traveling, or get behind schedule I’m open to eating something else.

Someone with OCD or a related disorder might feel that their failure to eat the required breakfast, could cause their day to be ruined. They might believe, even though they know it is illogical, that their failure to eat the required breakfast, in a specific order, could result in someone starving to death, or harm coming to a family member. These beliefs that their actions or inactions, can cause harm results in an overwhelming compulsion to perform actions.

I have used an extremely exaggerated example here, but I hope you can see the difference between an extremely strong preference and a compulsion. A compulsion is something you feel forced to do even when it makes no sense. It is as if the person with OCD is being controlled by an outside force.

Defining obsessions and compulsions.

Obsessions are persistent, unwanted, and intrusive thoughts, urges, or pictures that you can’t get out of your head. Compulsions are the things people feel required to do to reduce the tension caused by the obsessions. These behaviors are often done a specific number of times. Compulsions may involve inflexible rules which must be obeyed to prevent something bad happening. Some Obsessive-Compulsive Related Disorders involve self-injury, like hair pulling or skin picking, which continues despite efforts reduce or stop the behavior.

Classifying Obsessive-Compulsive Related Disorders.

In the past, Obsessive-Compulsive Related Disorders were scattered throughout the diagnostic manual. Some of these disorders were in the chapter on anxiety; some were mixed in with impulse control disorders, others were under somatoform disorders. A few were not even recognized as mental illnesses in the past. In the most recent DSM-5, these issues were brought together in a single Obsessive-Compulsive and Related Disorders chapter.

Sometimes it’s hard for professionals to diagnose which disorder a person has. It is possible for one person to have several of the Obsessive-Compulsive Related Disorders. Many people with Obsessive-Compulsive Related Disorders also have anxiety disorders, trauma and stressor-related disorders and some form of depression.

OCD leads the Obsessive-Compulsive Related Disorders parade.

Among the Obsessive-Compulsive Related Disorders, the best-known disorder is Obsessive-Compulsive Disorder, a serious mental health issue which is estimated to affect between 1% and 2% of the population worldwide.

Other Obsessive-Compulsive Related Disorders include Body Dysmorphic Disorder, Hoarding Disorder, Trichotillomania, (hair pulling), and excoriation (skin picking). All of these disorders significantly interfere with people’s lives. Symptoms in these disorders recur, despite repeated efforts to control or stop the Obsessive-Compulsive Related Behaviors.

Substances and medications can cause, or induce, Obsessive-Compulsive Related Disorders. Some medical conditions can also cause obsessive-compulsive behaviors. In the DSM-5 they are also seven other conditions lumped together under the heading Other Specified Obsessive-Compulsive Disorders. One of those conditions is Obsessional Jealousy. This is one of the few times jealousy counts as a symptom of a mental health disorder. More on Obsessional Jealousy in a future post.

Treatment for Obsessive-Compulsive Related Disorders.

The primary treatment for Obsessive-Compulsive Disorder (OCD) is exposure and response prevention therapy. While exposure and response prevention therapy has some similarities to systematic desensitization, which is used to treat specific phobias, relatively few therapists are trained in exposure and response prevention therapy.

One resource you may want to consult is the WordPress blog ocdtalk.  http://ocdtalk.wordpress.com/

For more information on Obsessive-Compulsive and Related Disorders see:

Obsessive-Compulsive Related Disorders category

Obsessive-Compulsive Disorder (OCD)

Body Dysmorphic Disorder

Hoarding Disorder

Trichotillomania, (hair pulling)

Excoriation (skin picking)

Obsessive-Compulsive Personality Disorder

David Joel Miller MS is a Licensed Marriage and Family Therapist (LMFT) and a Licensed Professional Clinical Counselor (LPCC.)  Mr. Miller provides supervision for beginning counselors and therapists and teaches at the local college in the Substance Abuse Counseling program.

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

For these and my upcoming books; please visit my Amazon Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

Why do you worry?

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Man worrying,

Some things you do not need to worry about.
Photo courtesy of Pixabay.com

Excess worry damages your mental health.

Many people know that worry and rumination can damage their mental health. Those same people may hold contradictory beliefs that they must worry to prevent bad things from happening.

People who hold both positive and negative beliefs about worry are likely to be higher in anxiety, experience more depression, and have impaired physical as well as mental health.

Positive beliefs about worry encourage worrying.

People who are high in worry, often have firm beliefs about the positive consequences of worrying. The way you think about worrying plays a role in creating and maintaining that worry. It’s hard to give up worry, no matter how painful it is, if you have positive beliefs about the benefits of worrying. If you worry a lot, examine your beliefs about worry. You may be expecting worry to play a role in life; it’s not able to fill.

People who worry a lot believe Worry will keep them safe.

People who worry a lot, often have a belief that worrying will make possible future negative events less likely to happen or will prevent those bad results from happening altogether. People who worry a lot expect that worry will reduce the consequences should a bad event happened.

Some worriers believe that worry motivates them.

Humans tend to be loss averse. Most people will work a lot harder to avoid losing something they have then they will work to get an item of equal value. If you worry about flooding, you may buy flood insurance.

When they are unhappy with their current job, a worrier is likely to put more effort into avoiding the loss of the current job then they will put into securing a new better job.

People who frequently worry may believe worry helps analytic thinking.

At the beginning of a project, most people see only probable success. Worriers have the belief that by worrying about what could go wrong they will spot possible dangers.

Frequent worriers believe that they need to control their thoughts.

People who are high in worry often believe that their brains will think dangerous thoughts. Sometimes they confuse the difference between thinking about something and causing it to happen.

Worriers are intolerance of uncertainty.

People who have difficulty accepting that some things are out of their control are at increased risk to develop excessive, pathological worry. People who are high in worry and anxiety believe they are responsible for controlling outcomes. Not being able to predict what will happen coupled with the belief that with enough thought and effort you should be able to control the results, can result in debilitating worry and anxiety.

Worriers use the “as many as I can” worry stop rule.

People who plan focus on the high probability issues. Worriers attempt to anticipate everything that could go wrong. Because of their efforts to anticipate every possible negative outcome, worriers spend a lot of time focused on low probability events and often are unprepared for the things that do occur. People who are low in worry use the “good enough worrying” rule. They worry only about a few high probability outcomes.

Worriers believe they must have cognitive confidence.

People who worry a lot, value high levels of confidence. They’re uncomfortable with uncertainty. Many life events contain large amounts of uncertainty. Worriers try to reduce that uncertainty by turning the possibilities over and over looking for other things that could go wrong.

People who worry a lot tell themselves worry is uncontrollable.

The focusing for worriers is on preventing negative feelings and consequences rather than on preventing worry. If you believe worry is uncontrollable, then it is something you are required to do. Believing worry is uncontrollable, but that you are responsible for controlling what happens leads to superstitious beliefs and may result in repetitive obsessive-compulsive disorder behaviors.

High levels of negative feelings create worry.

Feelings of pessimism, personal inadequacy or incompetence, and personal despair and hopelessness make it more likely they will worry. People who are sad or depressed are likely to worry more.

Worry can be used to avoid facing unpleasant life events.

When you worry, you can stay focused on what might happen, and you don’t have to think about what is taking place in your life today. Studies have demonstrated that people use worry as a way of avoiding unpleasant situations and feelings. By staying “up in your head” in worry, you can block the part of the nervous system that processes feelings.

If you worry a lot, now might be a good time to challenge some of the beliefs you have about worry.

David Joel Miller, MS is a Licensed Marriage and Family Therapist (LMFT) and a Licensed Professional Clinical Counselor (LPCC.)  Mr. Miller provides supervision for beginning counselors and therapists and teaches at the local college in the Substance Abuse Counseling program.

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

For these and my upcoming books; please visit my Amazon Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

How lonely will you be?

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Lonely person

Loneliness.
Photo courtesy of Pixabay.com

Will loneliness cause you problems?

Loneliness can result in significant emotional problems. While loneliness isn’t considered a specific mental illness, it plays a role in creating and worsening several mental health issues. Loneliness can undermine self-esteem by making people feel, empty, worthless and unwanted. Loneliness is both a cause of and a result of social isolation. If you are feeling lonely, you probably feel that you lack something in your life. Loneliness coupled with anxiety and depression increases your risk of feeling threatened and may result in paranoia.

In its milder forms, loneliness can be a motivator for you to seek out human contact. Stronger versions of loneliness result from feeling you have too few social connections or the relationships you have are one-sided and unhelpful.

Researchers have discovered strong connections between loneliness and depression. Lonely people are at an increased risk to think about suicide or to even attempt suicide. Lonely people are more likely to use and abuse drugs and alcohol resulting in alcoholism and addiction. The combination of substance use disorders, feeling lonely and depressed, and believing that others are rejecting you, increases the risk of violent behavior. Loneliness has also been linked to physical health problems and poor emotional development.

The very young and very old are at increased risk for feelings of loneliness. Particular life transition points also increase these risks.

Your thinking can make your loneliness better or worse.

How lonely you feel is less likely to be the result of how many friends you have or how much time you spend with others, and is more connected to your attitudes about the quantity and quality of your social connections.

Your feelings of loneliness are primarily the result of your beliefs about four separate factors. When you’re feeling lonely, it is important to look at both the facts and your beliefs in these areas. One way to reduce the feelings of loneliness is to develop the skills you need to change your situation. The other way to feel less lonely is to reconsider your beliefs about things. Often negative emotions are caused not by the situation, but by the beliefs you have about your circumstances.

What do you think about your friendships?

Loneliness is reduced more by having close, true friends, than by the number of casual friendships you have. It’s not how many friends you have, especially your social media friends, but how close you and your friends are.

True friendships should be reciprocal. You care about them, and they care about you. You should be willing to do for them, and they should be equally willing to do for you. If you find that your relationship is all about that other person, that you must do what they want to keep their friendship, that’s not a healthy, positive friendship.

It’s wonderful to have a BFF (best friend forever.) Having only one close friend limits the ability of your friendship to be supportive. No one will be able to devote every minute of their life to meeting your needs. If you call that one best friend constantly about your problems, you are likely to burn them out.

Recovery programs often recommend that you have at least five separate people in your support system. Your friends should have other people in their lives beside you. If you’re in a relationship where you can’t have other friends or where you resent the other people in their life, these are not healthy relationships.

Emotionally healthy people belong to a group of friends rather than being dependent on only one person. Having only one person to meet their emotional needs is a large issue for couples. When there are difficulties in your relationship, you will find it hard to turn to your partner for emotional support. It’s risky to turn to friends with whom you might be tempted to develop a close sexual relationship. For heterosexual people, this is the time you need to have friends of your own gender.

Are you isolated?

Feeling socially isolated causes loneliness. If you feel like you have no friends and no one you can talk to, this should prompt you to reach out and make connections. For some people, this means professional counseling, which can help in the short-term. In the long-term, you need to put yourself into situations where you can make friends, and need to learn the skills necessary for creating and maintaining friendships.

Is being alone a bad thing?

Your attitude towards solitude will magnify or reduce your feelings of loneliness. Ask yourself how you feel about spending time with you? Some people find that when they are alone, they don’t know what to do. Are you bored when there’s no one else around?

Being alone shouldn’t make you unhappy. Alone time is an opportunity to find out about yourself. Focusing on the negative will increase your loneliness. Feeling negative about being alone will cause the time to drag. Filling the alone time with things you enjoy doing turns loneliness into happiness.

Can Solitude be a good thing?

When you are alone, look for the positives. Your time alone should be an opportunity to get to know yourself better. Develop a friendship with yourself. Throughout your life, the one constant will be you. Everywhere you go, every minute of your life, you will be there. Work on enjoying the time you by yourself.

Life can get hectic at times. Sometimes it’s nice to get away from it all. If when you get that chance to get away from life’s hassles, you discover you’re getting lonely, consider developing a stronger friendship with yourself.

Other posts about feeling lonely will are found in the category – Loneliness.

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Your “feeling bad” may be Dysphoria.

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Unhappy

Dysphoric.
Photo courtesy of Pixabay.com

Dysphoria – the feeling bad problem.

Sometimes you just feel bad. Many times, people feel bad but can’t describe what that feeling is. Ask someone at random how they feel, and the most common answers will be, good, bad, or angry. Some of this stems from the bad reputation feelings have received. Many people go to great lengths to avoid any negative feelings. When you tried to avoid negative feelings, it’s no surprise that when you do feel bad, you have difficulty identifying that feeling and giving it a name.

You may have been labeled dysphoric without your knowledge.

If you have been to see a professional because you were “feeling bad” but you didn’t know the specific reason, the professional may have written down somewhere in your file that you were “dysphoric.”

When you’re under stress, the chemicals your nervous system produces are felt widely throughout your body. Panic attacks can feel like a heart attack. Depression can leave you exhausted, lacking the energy to get out of bed. A high percentage of clients who experienced these symptoms go to the medical doctor first. Which is not a bad idea. You need to rule out a medical issue. Sitting and talking to your counselor during your heart attack could be fatal.

Once your medical Doctor has ruled out immediate, life-threatening illnesses, you may be referred to see a psychiatrist, counselor, or therapist. Seeing a counselor does not mean you are crazy. What it tells us is that your nervous system has been sending out chemicals alerting the body to an emotional crisis. The result is an episode of dysphoria.

Is dysphoria a mental illness?

Dysphoria is a term that goes back to the days of Freud. Back then someone was either diagnosed with psychosis, that meant you were crazy, or neuroses which largely meant you were struggling with the problems of living. I have seen the term dysphoria in a lot of the older literature from the fields of psychology and psychoanalysis. Today professionals use the DSM-5 to diagnose mental illness. The DSM lists about 400 different varieties of mental illnesses. Dysphoria can be an underlying symptom of many of these illnesses, but it is not one specific disorder.

No client has ever told me they felt dysphoric. But I’ve heard that they “feel bad” plenty of times. I have seen the word dysphoria on assessment forms several times, usually as a checkbox for a feeling the client might be having. As my students have heard, I think of a good assessment as more than just checking the boxes and filling out a form.

To help someone who is “feeling bad” the counselor needs to examine that feeling, identify the specific feelings involved and ideally match them up with a specific mental, emotional, or behavioral problem.

What exactly is dysphoria?

OxfordDictionaries defines dysphoria as “a state of unease or generalized dissatisfaction with life. The opposite of euphoria.” Some words are easiest to define by saying that they are the opposite of something else. Unfortunately defining dysphoria by saying it’s the opposite of euphoria is not much help.

The Century Dictionary and Cyclopedia, from 1889, gets us closer to a useful definition. I think this is an important point. When you are reading books which were written a long time ago, Freud and Jung, even the psychoanalysts who wrote before the DSM Four, it’s important to ask what the words meant to them. The English language has always been in a state of change.

The Century Dictionary and Cyclopedia defines dysphoria as; pain hard to be borne, anguish, impatience under affliction, a state of dissatisfaction, restlessness, fidgeting, or inquietude.

In Psychology dysphoria generally means one of 3 things.

Martin Seligman in his book What You Can Change and What You Can’t begins with the idea of dysphoria and then breaks it down into three specific negative emotions. I would highly recommend this book by the way. One point he makes here is that to date there is no medication which cures any mental illness. At the time he wrote this book; he listed 14 mental illnesses that could be effectively treated, cured, or greatly reduced, using specific forms of talk therapy. I’m inclined to think in the years since he wrote this book other therapies have proven effective for additional mental and emotional disorders.

Anxiety can look like a physical illness.

Anxiety disorders are the “great pretenders.” During episodes of anxiety, the thoughts in the brain mobilize the body for flight or flight activities. Anxiety reduces a lot of physical symptoms in your body and is frequently mistaken for a physical illness.

Professionals split anxiety disorders into a number of specific types. Most are temporarily manageable with medication, but when the medication wears off the anxiety returns worse than before. Therapy of several varieties, coupled with relaxation techniques and life skills training can greatly reduce the levels of anxiety.

Recently, trauma and stressor-related disorders such as PTSD were separated from the Anxiety Disorders. These problems have added symptoms such as nightmares and flashbacks. There are treatments for these disorders, but those treatments are very different from the ones used for anxiety.

Depression comes in many varieties.

Professionals categorize depression more by the physical symptoms you experience than by the cause of the depression. Some types of depression have a specific cause, and others don’t. Many of the symptoms of depression look like those of physical illness. Changes in appetite, eating either too much or too little, can all be part of depression. Changes in sleep are also an element of depression. Some people, when depressed, experience significant fatigue. Depressed people may take to bed and feel too tired to get up. Underlying depression is the loss of the ability to experience happiness. Some people can feel a few bursts of pleasure, but the temporary pleasant sensation quickly fades.

Anger and irritability are often components of dysphoria.

When someone doesn’t feel well, they are out of sorts, they become irritable and push others away. Some people feel “bad” and experience a lot of anger. Neither anger nor irritability is considered a specific mental illness, but they may be symptoms of several mental health challenges.

It would be wonderful if there were specific blood tests or x-rays that would determine that the physical symptoms you have are the result of dysphoria and could be identified as one specific mental illness. Unfortunately, it doesn’t work that way. First, you need to see a medical Doctor to rule out physical illness. Next, you would see a counselor who would talk to you about your symptoms. Based on the number and severity of symptoms you would get a specific diagnosis.

Treatment should be tailored to you and your particular symptoms. Therapy is not something the counselor should do to you. Therapy is something the counselor and client do together. As a result of counseling, you should learn skills and new ways of thinking that will help you manage dysphoric feelings and learn to increase the number of positive feelings you experience.

If you have been feeling bad, one or more of the dysphoric feelings, please consider getting help.

Staying connected with David Joel Miller.

David Joel Miller MS is a Licensed Marriage and Family Therapist (LMFT) and a Licensed Professional Clinical Counselor (LPCC.)  Mr. Miller provides supervision for beginning counselors and therapists and teaches at the local college in the Substance Abuse Counseling program.

Two David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

For these and my upcoming books; please visit my Amazon Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

Cocaine and methamphetamine-induced paranoia

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Grim Reaper

Paranoia.
Photo courtesy of Pixabay.

Stimulant-induced paranoia isn’t exactly a diagnosis.

Paranoia is common among drug users. It’s especially common among stimulant users. When crack cocaine users first began to show up in hospital emergency rooms, there was a lot of confusion between drug-induced psychosis and the onset of schizophrenia and other psychotic disorders. For a while, it looked like there was an epidemic of new cases of schizophrenia. Then picture emerged, something was very different about these new cases of psychosis.

The key features of psychotic disorder, schizophrenia, and some other related disorders are delusions, hallucinations, disorganized thought and speech, and grossly disorganized or abnormal motor behaviors. Some loss of normal functioning called “negative symptoms” is also part of psychosis. People with drug-induced psychosis don’t show those same levels of “negative symptoms.”

What most of us think of as paranoia fits generally under a couple of types of delusions, persecutory delusions, and referential delusions. These are the beliefs that people are out to get them and that what others are saying and doing is directed at them. Researchers have discovered that symptoms of paranoid can fall on a continuum from some mild suspiciousness and trust issues to potentially dangerous psychotic paranoia.

Psychosis and presumably paranoia can occur at multiple points in the drug using experience. For any drug of abuse, we expect to see one set of symptoms while the user is under the influence and another set of symptoms during withdrawal. Some conditions will persist, sometimes for years, even after the drugs have left the users system. These conditions are called drug-induced. It’s also possible that a drug user had a particular mental illness before they began using or had a risk factor for an illness and the drug use was enough of a stressor to result in the appearance of that illness.

I should also mention here all these descriptions are based on the idea that mental illnesses are categories. That’s the way the diagnostic manual is designed. You either have the illness, or you don’t. Increasingly research has been suggesting that most of the things we are calling symptoms are on a continuum. You can have more or less of a symptom such as paranoia. This implies that counseling and the ways people think can result in changes in symptoms of something like paranoia, regardless of whether the person with paranoia has a diagnosable mental illness or not.

Paranoia among cocaine users.

Cocaine-induced paranoia is primarily reported during cocaine intoxication. It involves extreme hypervigilance for possible danger in the environment. Up to 70 percent of cocaine users exhibit temporary paranoia even after ruling out mental health diagnosis which would include paranoia. Cocaine users on average report developing paranoid symptoms after about three years of using cocaine. The quantity that was used or the patterns of use do not seem to affect the onset of paranoia (Rosse, et al., 1994.)

Methamphetamine-induced paranoia.

Studies of paranoia among methamphetamine users are generally newer than the ones involving cocaine. One noteworthy difference was that methamphetamine users who became paranoid were more likely to get a weapon and to attack someone. Meth users had typically been awake for 48 hours or more when the paranoia began. The majority experienced auditory and visual hallucinations. Almost 40 percent of the methamphetamine users also reported tactile hallucinations. These results not only overwhelmingly reported paranoia but fit more closely with the diagnosis of psychosis in the studies I found of psychosis in cocaine users (Leamon, M., et al., 2010.)

Other drugs probably cause paranoia also.

Most of the early research on stimulant psychosis was done using patients who had been addicted to crack cocaine. In the years since that research, it has become clear that other stimulants, methamphetamine and the so-called “bath salts,” also produce psychotic episodes and an increase in paranoia. Studies of paranoia among cocaine users were largely done in psychiatric settings while the studies of methamphetamine and paranoia were mainly done in outpatient drug treatment which leads me to believe that paranoia is probably much more common and more likely to lead to violence among those who develop severe methamphetamine use disorders.

Paranoia and hallucinations occur among users of dextromethorphan.

Since most drug users use multiple drugs as well as drink alcohol and many also have mental health issues, it’s hard to be sure about causes. One thing does seem certain almost all drugs of abuse and excess alcohol use result in an increased risk that you will develop some level of paranoia.

For more on this topic see:

Trust

Paranoia

Dextromethorphan and paranoia.

Staying connected with David Joel Miller

Three David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

SasquatchWandering through a hole in time, they encounter Sasquatch. Can they survive? The guests had come to Meditation Mountain to find themselves. Trapped in the Menhirs during a sudden desert storm, two guests move through a porthole in time and encounter long extinct monsters. They want to get back to their own time, but the Sasquatch intends to kill them.

For these and my upcoming books; please visit my Author Page – David Joel Miller

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For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

Coping with life’s regrets.

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Regrets.

Regret.
Photo courtesy of Pixabay.com

Don’t let regrets about the past ruin the present and future.

Do you have regrets? Maybe they are small ones; you wish you bought the other color or model. Maybe your regrets are big ones, actions that caused you or others pain, things you wish you could go back and change. But you can’t change the past. Almost everyone has regrets, some small, some large, a few even gigantic. So, what to do with those regrets? How do you get past the pains of your past?

Fix the things you can.

You can repair some things. You said or did something that damaged a relationship. Sometimes you can apologize, say you’re sorry. If you owe somebody money you can pay it. Sometimes an apology is not enough. Maybe you need to do something to make it right, to make your amends to the person you have injured.

Undo yes and no decisions.

You can undo some decisions. You said yes to a job or attending a party and now you wish you hadn’t said yes. You’re entitled to change your mind. Call that person, send them an email. Maybe you said no to something or someone, and now you wish you had said yes. Check it out; sometimes it’s possible to change your mind.

Pick a new alternative from life’s menu.

Sometimes changing your decision is no longer a possibility. For example, you wanted to attend a concert but didn’t buy the tickets in time. Look for other options. Maybe the person or group you wanted to hear is performing somewhere else nearby. Maybe there’s some other event you would enjoy instead. Don’t stay stuck in regret over the relationship that didn’t work out, maybe it’s time to meet someone new.

Only take responsibility for your part of the problem.

A lot of life’s regrets are about relationships. Maybe it was an argument with a family member or friend, that conflict cost you a relationship. Take responsibility for your part of the conflict. You can’t take responsibility for what the other person did or said. If you can fix it do so, but not at the cost of ignoring the other person’s part in the problem.

Reevaluate the alternatives. You may have picked the best alternative you had.

Sometimes you must pick between two bad choices. Don’t be so hard on yourself. You may have made the best choice you could under the circumstances. Be careful of hindsight. If you would have had the information you have now back then, you might have made a different decision. But you didn’t have that information, and you had to choose. Don’t spend the rest of your life stuck in regret.

Learn from your mistakes.

Don’t be one of those people with tons of regret who keeps doing the same things over and over. Stop piling up new regrets by learning from your mistakes and making improved decisions in the present.

Practice extreme acceptance.

Staying stuck in regrets can use up a lot of energy. Practice accepting that what happened is in the past. Avoid ruminating and allowing your mind to enlarge the pain. Shift your focus from regrets about the past to opportunities for better future.

Stop looking over your shoulder at the past.

The past is gone. Don’t keep looking back at the things that can’t be altered. When the thought of that regret comes up, practice shifting your focus to the future. As long as your alive there will be more events ahead on the road of life. Look forward to making your future the best it can be. If you only look for the bad in life, you will find it. It’s quite possible that all around you are opportunities for happiness here in the present and in the future.

Do some psychological repair.

Make healing from life’s regrets a priority. Sometimes you will have a close friend with whom you can talk it through. You may need to be careful about who you tell what. Telling family or friends about things you regret may damage your relationship. If you are not sure how someone will react to hearing about your regrets, that person may not be the one to talk with. Once you tell that secret, it can’t be untold. Some people find it useful to journal, write out how they feel in a document meant for only them to see.

If you’re having trouble processing and dealing with regrets, you may need to seek professional counseling help. Don’t stay stuck in a life dominated by regrets. Use some of these approaches to change what you can, and accept what you cannot change.

You find more about this topic under Regret.

Staying connected with David Joel Miller

David Joel Miller MS is a Licensed Marriage and Family Therapist (LMFT) and a Licensed Professional Clinical Counselor (LPCC.)  Mr. Miller provides supervision for beginning counselors and therapists and teaches at the local college in the Substance Abuse Counseling program.

Two David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

For these and my upcoming books; please visit my Amazon Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.