Category Archives: substance use disorders

Side effects by being impregnated by a Methcathinone user? – Morning Question #20

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

Counseling questions

Counseling questions.
Photo courtesy of Pixabay.com

Should you worry if you get pregnant by a Methcathinone user?

Anything that damages an egg or the sperm could result in birth defects, age, the physical health of either party, and so on. There is always a risk of spontaneous mutations and genetic damage. I have not seen much good research that indicates that one drug is better or worse than another when used by the father.

ANY drug use by the mother during pregnancy is risky. Sorry ladies. Doctors even take pregnant women off some prescribed medications. Alcohol is the biggest risk factor for preventable birth defects we know of. The only fully safe amount of alcohol a woman should consume during pregnancy is NONE!

If you are worried about the drug use of the father of your child you have more to worry about than possible birth defects. YOUR BABY’S DADDY MIGHT BE A DRUG ADDICT.

Pick your baby’s daddies and mamma’s wisely, you can break up with your partner but your child’s other parent is forever.

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

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.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

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

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

For videos, see: Counselorssoapbox YouTube Video Channel

Could psych meds kill?

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

Drugs

Drug counseling.
Photo courtesy of Pixabay.com

Taking your medication could kill you or someone else.

When we think of drug-related deaths we think first of illegal street drugs and overdose deaths but in fact, legal drugs or medication kill a lot more people than the illegal ones. Psych meds do result in deaths and serious injury.

Several recent studies have highlighted the dangers of taking a prescription medication and driving. The problem of impaired drivers includes those taking prescribed psychiatric medication. A recent large study in Taiwan confirms what other studies in the United States have suggested. There is a definite link between taking some, but not all, prescription psychiatric medication and serious car accidents.

At the top of the list for possible danger is sleeping medications. Sleeping pills have been implicated in episodes where people who have no history of substance abuse still had a “blackout” and drove without a memory of taking the trip. Now we have evidence that people who take sleeping pills are more likely to be involved in serious accidents. Even if you do not feel impaired you may be at risk. The person who is in no shape to drive is also the person who can’t tell if they are impaired.

Anti-anxiety medications particularly Benzodiazepines have been involved in a number of cases of serious car accidents.

Antidepressants are also present in the system of people who are involved in accidents in a disproportionate number of car crashes. Why antidepressants should be involved is still unclear.

Surprisingly the recent studies have not shown any significant connection between antipsychotics and accidents.

It is not those diagnosed with paranoid-schizophrenia but the anxious-insomniacs who are crashing into us.

My guess is that the increased use of the newer atypical antipsychotic medications has resulted in people with psychosis leading better, safer lives.

Another overlooked factor in accident prevention has been the association between marijuana smoking and serious car accidents. Most people know about the connection between alcohol and accidents but weed?

Studies have shown that the majority of drivers involved in serious accidents are positive for marijuana (THC) at the time of their accident. Either smoking marijuana is increasing your risk of an accident, or most people these days are smoking weed.

Regardless of your feelings about marijuana, drug legalization or decriminalization there appears to be a connection between being high on weed and getting in an accident. So if you smoke I would prefer it if you stayed off the road, especially while I am out there.

So now we know more about this subject of medications, drugs, and driving.

It is not just illegal drugs or alcohol that can impair your driving ability, prescribed drugs including some psychiatric ones also can increase the risk of you hurting yourself or others while driving.

The combination of prescribed medication, street drugs, and or alcohol, is just asking to be in a serious accident.

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

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.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

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

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

For videos, see: Counselorssoapbox YouTube Video Channel

Mania in children?

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

Person with masks

Bipolar.
Photo courtesy of Pixabay.com

Do children really have mania?

Parents bring children into the emergency rooms and the psychiatric facilities because their child “flips out” and begins damaging property. Say the child begins breaking out all the windows in a row of buildings. They are angry and out of control. Efforts to get them to stop are unsuccessful and they may continue even when threatened with violence. Is this an early sign that the child has Bipolar disorder?

Diagnosing Bipolar Disorder in children is highly controversial. To make that diagnosis we need to know if children really have episodes of mania or hypomania. No mania and there should be no Bipolar Diagnosis. Anger and mania are related; they may overlap but are they part of the same thing? The researchers in this area are clearly not in agreement. I will save my opinion for the end.

Children have temper outbursts. If we reduce the level of symptoms needed to include those outbursts as a mental illness all children would get the label and the diagnoses would become meaningless.

To be considered Mania it should last 7 days, for Hypomania an episode needs to last for at least four days. This rules out all those brief temper outbursts from consideration.  It also excludes those times when any and all of us might have a time period of excitement when we sleep less or are excited to pursue a new activity, like a new love interest.

Recently there has been an increase in the use of the Bipolar NOS diagnoses in children because this allows for some judgment calls as to the length of the episode needed to make the diagnosis. One study (Stringaris et al. 2010) looked at children who had been diagnosed with Bipolar and concluded there was no evidence of mania in children under the age of thirteen, meaning no child that young should be getting the diagnosis of Bipolar. Other researchers disagree.

Stringaris did find that of those children who had brief episodes, too brief to meet criteria for a hypomanic episode, fully 25% did go on to develop all the symptoms needed to diagnose Bipolar Disorder within two years. His conclusion is that we should wait until the teen years and the full criterion is met before diagnosing Bipolar Disorder.

This is a problem for me. Why would we begin treating a child if they do not have an illness? No diagnosis no treatment. So to get the family the help they need, we need the diagnosis. If not Bipolar Disorder then what would we call this child’s problem? Also, the study tells us that 25% of these brief episodes will develop symptoms in 2 years. What about 10 years or 20?  I have not yet found research that answers those questions.

Early-onset researchers come up with a different answer. Telling us that – Mania, Bipolar one mostly starts in the adolescent period (McNamara, 2010.) This study goes on to cite 6 factors that may constitute risk factors for the early development of Bipolar Disorder.

One significant risk factor is a history of being the victim of abuse and neglect. We know that early childhood experiences can induce changes in the wiring of the brain. So can later life traumas. Psycho-social stressors are also listed as risk factors. These are also risk factors for personality disorders and other mental illnesses.

This tells us that experience and learning can be risk factors for developing Bipolar Disorder.

A family history of Bipolar is also a risk factor. Not just family members living in the home, but first-degree family members who have any mood disorder, whether in the home or not, appear to increase the risk of developing Bipolar.

That says that heredity is a risk factor for Bipolar Disorder.

A history of substance abuse, prescribed antidepressants and stimulants, and dietary deficiencies all have been implicated as having a connection to Bipolar disorder.

See: Do medications and drugs cause Mania or Bipolar Disorder and other Co-occurring blog posts

Lastly, McNamara sums up the argument for diagnosing Bipolar Disorder in children by saying that most people who go on to get the diagnosis had “prodromal” or early symptoms 10 full years before they were diagnosed.

We know from other mental health research that the sooner an illness is recognized and treated the better the chance of a full recovery.

My opinion

Children who have a brief – one day temper or behavioral outburst are unlikely to be having Bipolar disorder. This is anger or bad behavior and you should try treating them for anger and behavior first. But the pattern needs monitoring.

There are dangers from over-treating psychiatric illnesses in children and there are dangers of under-treating. Pick a provider you trust and listen to their advice and judgment. I especially recommend a consultation with a child psychiatrist whenever possible.

Don’t adopt a wait and attitude, even if you decide to skip the medication for now, if your child has these kinds of symptoms get the child counseling or therapy.

Care to share or comment?

Has your child had outbursts that looked like mania or hypomania and have you considered the possibility they may have Bipolar disorder?

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

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.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

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

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

For videos, see: Counselorssoapbox YouTube Video Channel

Types of Mania and Dual Mania

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

Person with masks

Bipolar.
Photo courtesy of Pixabay.com

How many types of mania are there?

Just what mental health symptoms are illnesses and how many mental illnesses are there? Counting Manias is especially difficult.

We think we know mania when we see it, but it is such a diverse group of symptoms that it has become established as “manic episodes” that are building blocks of diagnosis, rather than separate diagnoses. It functions primarily to separate Bipolar Disorder, formerly called manic-depressive disorder from the other depressive conditions.

Mania has been described as the most heterogeneous mental health symptom there is, raising the question “When we say mania are we all talking about the same thing?” Are there types of mania that have different causes and indicate varying diseases?

Currently, there are over 400 recognized disorders or conditions that might be the focus of treatment in the DSM-4. As you may have seen from previous posts many of these disorders have lots of subtypes that look different in practice and may require different treatments.

Mania and Bipolar disorders are especially difficult because of their wide diversity of symptoms. For more on the DSM-4 and some to be DSM-5 descriptions see: What is mania? And What is hypomania?

Encarta Dictionary definitions of mania include:
1. An excessive and intense interest or enthusiasm for something and 2. A psychiatric disorder characterized by excessive physical activity, rapidly changing ideas, and impulsive behavior. The two uses of the word mania don’t have a lot in common.

Kraepelin, whose work has formed much of the foundation for modern efforts to divide up and diagnose illnesses, reported there were 6 types of mania. His distinctions seem to have been blended together into the one thing we now call Mania. But are all manias really the same?

Research has been less than helpful here as most researchers exclude a lot of people from their studies. If you exclude enough people, for enough reasons, the group left may look all alike. That does not mean the resulting study tells us anything about the various problems people with mania are undergoing.

One study (Haro et al., 2006) tells us that they found three very different forms of mania. The most common form of mania they called “typical mania” and this group contained 60% of the people in the study. But the other 40% had symptoms that were so different that the authors separated them into two additional subtypes of mania.

Psychotic mania is not like “Typical mania.”

Psychotic symptoms sometimes end up in making mania for a bipolar diagnosis but psychotic episodes can occur in other illnesses such as schizophrenia. It is common for families to have members who have been diagnosed with bipolar disorders and others who were diagnosed with schizophrenia. Psychotic mania looks a lot like psychosis and bipolar at the same time, but then we have another illness schizoaffective disorder to use for that also. This leaves the diagnosis of psychotic Bipolar in doubt. I have seen doctors record a diagnosis of schizophrenia – bipolar type.

Dual Mania is similar to other dual diagnoses

Dual Mania was described by Haro et al. as significantly different from other types of mania. Dual-diagnosis mania has been poorly recognized simply because most people who abuse substances are routinely excluded from research studies. Haro et al. report that this systematic exclusion of people with multiple problems leaves a huge gap in our understanding of mania and therefore Bipolar Disorder.

Dual Diagnosis client with mania spent significantly more days in the psychiatric hospital and had more suicide attempts. This is consistent with other studies that have shown people with Bipolar Two are at the highest risk for a suicide attempt and that people who abuse substances have higher risks also. Unfortunately acutely suicidal clients are also routinely excluded from studies of mania and Bipolar Disorders despite there being overrepresented in substance abuse treatment and acute psychiatric facilities.

Other characteristics of clients with “dual mania” included being male and younger than others with a manic episode. Dual mania resulted in higher disability levels. Dual mania was also more likely to cause job and relational problems.

Of those clients in the Haro et al study, 25% had a history of alcohol abuse. Of those with dual mania, 40% had a history of marijuana use or abuse. So that means many dual mania clients had abused both.

In substance abuse treatment the pattern of alcohol and marijuana use coupled with job, relational and legal problems is so common as to be almost universal. Among those in treatment for methamphetamine abuse, manic and hypomanic symptoms are commonly reported even when the client is not using drugs. Episodes of manic or hypomanic symptoms are also commonly reported as triggers for substance abuse relapse.

Of those with long-term mania and multiple hospitalizations the “aggressive type, ” all had histories of substance abuse (Soto, 2003.) This study did not specifically include a substance abuse type of mania but noted that among those with long-term mania and a history of substance abuse those who had not used in the last 30 days were no different than those who had used or drank. The suggestion to me is that there is something different about those who experience mania and abuse substances. Mania predisposes people to abuse substances and both conditions need to be treated.

My conclusion

The continued exclusion of substance abusers and those who are suicidal results in research data that excludes those at the highest risk and those who most use mental health services.

Comments on Mania, Bipolar co-occurring disorder, and recovery, and most anything mental health-related are always welcomed.

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

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.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

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

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

For videos, see: Counselorssoapbox YouTube Video Channel

What if you go to the hospital drunk or high?

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What if you go to the hospital drunk or high?
Photo courtesy of pixabay.

By David Joel Miller.

Hospital emergency rooms are filling up with people under the influence.

This is causing a whole lot of problems for hospitals, the emergency room staff, and society in general. There is no special reason why someone needs to go to a hospital because they are drunk or high unless they also have a medical or psychiatric emergency.

They end up there because of the other problems drug and alcohol use cause to the person and to society. Often this happens because there is just no other place to send them. Hospitals do not function as an extension of law enforcement and patient privacy is strongly enforced so unless you are in prison when the emergency occurs don’t worry about seeking help because of the legal consequences.

People who are drunk or high are a lot more likely to slip, fall, or otherwise injure themselves. The emergency room staff is used to this and unless you broke some major law like hitting someone while driving drunk and you are already in custody, their goal is to get you patched up and out of there.

Some under-the-influence people really really need to be in the hospital.

If someone has the Delirium Tremens (DT’s), they need to be in the hospital, this is life-threatening. But most drunks are just a pain to the workers in the ER. They argue, try to go places, and do things that just get in the way.

Heroin and other opiate abusers need an injection to reverse the effects of the overdose, but most enlightened emergency responders carry the injection to do this on the ambulance so that by the time the patient reaches the hospital the emergency is over.

Drunks are most problematic because the alcohol impairs their judgment. They are often suicidal or violent. No not everyone who drinks gets suicidal or violent but many suicidal people abuse substances. A binge drinker is 55 times more likely to attempt suicide than a non-drinker.

Substance abusers make up a significant proportion of admissions to psychiatric facilities. While they are under the influence they are prone to be violent and irresponsible. Some of them are still suicidal or violent after the drugs and alcohol wear off and need further treatment.

Since we don’t know if the current psychiatric problem is only a result of the substance or do they have these issues at other times. Most suicidal, self-harming, or violent people who are under the influence end up staying until the drugs and alcohol wear off and they can rationally answer questions about their behavior and intent.

One very effective approach to this overflow of under-the-influence people filling up the hospital ER’s has been the creation of sobering centers.

Situated close to the hospital and under the supervision of medical staff, trained Para-professionals such as substance abuse counselors and mental health professionals can screen patients for medical necessity and supervise detoxification. These systems have worked well. Unfortunately, when budgets get tight, detox, as well as other services for substance abusers and the mentally ill, get cut.

At the time the need is the greatest detox and sobering centers are the most likely to get cut and throw their work back on the already overused ER’s.

Hospitals are also seeing a surge in irrational people as a result of synthetic drug use. (See 7 new drugs parents should be aware of.) Sometimes that psychosis goes away once they detox but other times it seems to be long-term and results in a psychiatric hospital admission.  Professionals are debating whether the new drugs are creating the psychosis or just a stressor that causes the first occurrence of the disorder.

I am convinced that drug use is damaging some brains and creating mental illness which would not have occurred without the drug use. I understand that not everyone agrees with this position.

So the conclusion to all this is that if you or someone around you is drunk or high and there appears to be a medical or psychiatric emergency you should go to the hospital and get checked out and do not worry about the police finding out about this as a result of your visit. If there is no medical or psychiatric problem and no past history of problems most people do not need to go to the hospital. When in doubt call 911, the doctor or hospital first, not your therapist or the social worker.

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

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.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

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

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

For videos, see: Counselorssoapbox YouTube Video Channel

Pink elephants kill – Dangers of Delirium Tremens (DT’s)

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

Inebriated people.

Alcoholism.
Photo courtesy of Pixabay.

Seeing bugs when drinking?

There are lots of jokes about people seeing things while drinking. Having Delirium Tremens (D.T.’s) is no joke.

Withdrawal from alcohol can be fatal. When we mention withdrawal from drugs most people think of the physical symptoms of heroin withdrawal. Kicking Heroin can make someone wish they were dead, but alcohol withdrawal is far more likely to kill.

Deaths directly related to alcohol each year exceed all the deaths from other drugs, legal and illegal.

DT’s occur when the drinker is withdrawing from alcohol as the blood level is declining. Before modern medicine was available up to one-third of alcoholics with DTs died during withdrawal. Modern medical treatment has cut that rate dramatically but people do still die while sobering up.

If the drinker has EVER had hallucinations or a seizure when drinking or detoxing they need medical attention and should be detoxed in a hospital.

Other symptoms of DT’s can include fever, shakes, and formication. Tactile hallucinations, bugs or snakes crawling over the skin are commonly associated with the DT’s. These symptoms are sometimes worse at night and can begin to occur days after the last drink as the body attempts to adjust to the absence of alcohol.

Any unusual symptoms that occur when an alcoholic stops drinking should be checked out by a medical professional.

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

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.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

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

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

For videos, see: Counselorssoapbox YouTube Video Channel

Does a drunk suicidal person go to jail?

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

Does a drunk suicidal person go to jail?
Picture courtesy of pixabay

When the law, medicine, and mental health intersect.

Sometimes people have more than one problem.

What happens when someone has a medical problem, a psychiatric problem and they break the law? When something interacts with the law the law usually wins. How these cases at the intersection of disciplines are resolved depends on the laws in your jurisdiction. Most places in the United States have similar statutes often based on uniform law statutes. More and more places on earth are recognizing that mental illness is not a choice and that the mentally ill need special consideration in their encounters with the law. Here are some of the possible outcomes of a drunken suicidal person based on what happens here in my jurisdiction.

Partly this depends on the order in which things happen. Do they go to the hospital for a heart attack and then we discover they are drunk and suicidal? Or have they been arrested for driving under the influence first? What if they killed someone while drunk and now are thinking of killing themselves. All very different scenarios.

While I separate medical, psychiatric, and correction issues, some places may have facilities for several of these issues. Hospitals may have psychiatric units, in custody units, and so on.

Crisis issues should always get the first look.

If someone is having a heart attack or bleeding to death they need immediate medical attention. They go to the hospital. If medical problems show up while they are in jail or the psychiatric facility they should be transferred to a medical hospital unless where they are also offered that second service.

Alcohol is one of the most life-threatening of all the drugs from which to detox. People can and do die from alcohol withdrawal. If someone has ever had the Delirium tremens (DTs) they are at risk to die while sobering up. This needs to be supervised by a medical doctor.

If someone is suicidal they need psychiatric care.

We have a procedure here in California for placing someone on a psychiatric hold (technically a request for evaluation) and getting them sent for an evaluation. That first hold is only good for 72 hours. After that, a psychiatrist needs to say they need to stay or they get discharged. If they committed a crime they might get discharged from the psychiatric facility and still face legal charges.

Once at a psychiatric hospital and under the care of a psychiatrist, they will be evaluated and kept until the crisis resolved. The laws have lots of safeguards to keep people from putting other people they don’t like away and keeping them locked up for long periods of time.

Once upon a time – people stayed in psychiatric hospitals for a long time. Stays of several years or even forever commitments were common. Not anymore. Since the advent of effective medications, stays at psychiatric hospitals are getting shorter and shorter.

Stays of a week or less are now common. A long-term stay in the psychiatric facilities I have worked in would now run two weeks to a month.

Killing yourself or attempting to is illegal in most places, only the most rabid law and order types would even consider chasing someone down and arresting them because they had thought about suicide while drunk.

With the intoxicated person, they are likely to change their mind about suicide once they sober up. Studies show that people who are binge drinkers, when they drink they get drunk, are 55 times more likely to attempt suicide than people with no alcohol in their system.

So generally speaking a drunken suicidal person will not be sent to jail. If nothing else the jail does not want people killing themselves while in jail. Having clients die in your facility is bad for a business even if you run a jail or prison.

No jail for the drunken suicidal person – unless –

If the drunken person has committed a serious crime while intoxicated they are still held liable. Being drunken is not an excuse for bad or illegal behavior. Being mentally ill does not, and should not, get you a pass either.

You may not go to prison, but you will have consequences, like time in a hospital for the criminally insane, until we are sure you understand what you did and are capable of not doing that again.

Jails do have psychiatric units and they do have to put people who were arrested for serious crimes on a suicide watch from time to time. But no, most times, they have no interest in arresting and detaining someone who is suicidal.

For the record – people who are placed on a psychiatric hold are not under arrest. This does not result in a police record or mean you will have to say yes to having been convicted of a misdemeanor or felony on a job application. Your psychiatric treatment record is supposed to be confidential just like your medical treatment record. Do not let the fear of legal consequences stop you from calling for psychiatric help if someone is suicidal. Dead people do not worry about having a record.

One consequence of being in the psychiatric hospital will likely be a form you sign at discharge that tells you that you cannot buy or own a firearm for five years after being in a psychiatric hospital. If you want to get a gun, then you will need to appear before a judge and convince him you have a good reason to own one.

But if you are the sort of person who gets drunk and then thinks about killing yourself and others, you are not the kind of person that I would like running around my neighborhood with a weapon.

If someone is medically sick they need to be in a hospital, someone who is suicidal needs psychiatric care, and someone who breaks the law gets arrested. When someone has more than one of these issues we may have trouble figuring out what to do.

Hope that answers the question a reader sent in “Does a drunk suicidal person go to jail?” If you have more questions or comments on the issues of suicide, intoxication, and our society’s response to people with multiple problems please leave a comment.

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

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.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

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

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

For videos, see: Counselorssoapbox YouTube Video Channel

Is nicotine a stimulant or a depressant?

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16

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

Full ashtray

Smoking cigarettes.
Photo courtesy of Pixabay.com

Is Tobacco an upper or a downer?

Half the articles I read tell me that Nicotine is a depressant. The other half, just as authoritatively, say it is a stimulant. It can’t be both, can it?

Smokers will tell you that when they get up in the morning they need a smoke to wake them up and get them going. Those very same smokers will tell you that at bedtime then need one last cigarette to calm them down and put them to sleep. How is this working?

Nicotine is one of a very small group of chemicals, probably the only one that is in common use, which works as both a stimulant and a depressant. Chemicals like this are called Biphasic.

Pure Nicotine is very, very poisonous.

As an insecticide, in its pure form, it will kill insects like crazy. But as a pure chemical, if it is sprayed on a field and gets on workers, those laborers will end up in the hospital and may die. So why doesn’t it kill smokers, quick like? If it killed you the first time you used it, there wouldn’t be many long-term smokers would there?

The nicotine from three packs of cigarettes, if consumed in pure form, would kill the average adult. A child could die from much less. Most of the nicotine in a cigarette is broken down by the burning and is taken in slowly, a small amount at a time. This result is a chronic low-level of the poisonous chemicals in the bloodstream rather than a single large fatal dose. A small child or pet eating a few cigarettes could reach a toxic, fatal level.

Most cases of nicotine poisoning and death are the result of being exposed to highly concentrated nicotine used as an insecticide. While nicotine was commonly used as an insecticide in the past, it has been replaced by newer more modern insecticides.

The one area in which nicotine is still permitted is in “organic” crops since nicotine is derived from a plant. Some countries have banned the use of nicotine as an insecticide and it appears likely that even the use for organic food will soon be eliminated.

Nicotine’s effects depend on the blood level.

In the early stages, the nicotine stimulates many responses in the body. The smoker, by taking in that first puff in the morning, believes they are energized.

As the day progresses the levels of nicotine in the bloodstream fluctuate. After each smoke, the level rises. The body, principally the liver, attempts to remove the toxin and the level is reduced. This up-down action creates the craving the smoker experiences.

The administration of any drug in many small doses, particularly by smoking, increases the addiction potential.

Late in the day, the smoker will have achieved a relatively high level of nicotine in the bloodstream. At high doses, the nicotine begins to depress systems in the body. Just before bedtime, the habitual smoker will smoke more in a shorter period of time in an effort to relax for sleep. The level of nicotine will slowly fall during the night as the liver detoxifies the drug.

Smokers instinctively respond to these low dose – high dose effects. A smoker who is trying to feel stimulated will take many short puffs. The smoker trying to sedate themselves will take fewer long puffs and raise the level in the bloodstream more rapidly.

It seems likely that many poisonous chemicals would affect the body in the same biphasic way. At low doses, the poison stimulates the body to defend itself and at high doses, the body shuts down under the effects of the poison. Nicotine, unlike many other poisons, is different in that it is able to produce these body and mind-altering effects which users find so pleasant while producing the diseases and death slowly over time rather than quickly.

Nicotine withdrawal.

Another reason for Nicotine’s calming effects is that repeated smoking counteracts the withdrawal or abstinence effect. As the level of nicotine in the smoker’s body drops they begin to experience withdrawal and become agitated. By replacing the nicotine in the bloodstream the smoker is delaying the withdrawal and reliving the agitation.

Tobacco keeps its users alive and dependent on it for their mood state changes for as long as it can.

Why do the effects of nicotine on the body matter to readers of a blog on mental health and substance abuse issues?

Because, by one report, the majority of cigarettes consumed in America are smoked by people with a diagnosed mental illness. Hope this post helps explain the way in which nicotine can both stimulate and depress the body.

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

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.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

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

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

For videos, see: Counselorssoapbox YouTube Video Channel

Blackouts – common or rare?

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

Drinking

Binge drinking.
Photo courtesy of Pixabay.com

Are blackouts common?

Morning Question #15.

Blackouts are nothing like passing out or being unconscious. Blackouts involve the ability to walk, talk, and function while intoxicating but to form no memories. The next day the drinker may not know what happened.

Blackouts are relatively common, with up to half of all college students reporting having had an episode of memory loss when drinking. These episodes are highly associated with Binge Drinking. Blackouts range from “brownouts” sometimes called fragmentary blackouts where there are portions of memory mixed with missing facts to full-on blackouts (sometimes called block blackouts) of having lived hours or sometimes days with no memory of where you were or what happened.

Having a blackout especially early in your drinking career indicates a huge risk of developing alcoholism.

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

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.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

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

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

For videos, see: Counselorssoapbox YouTube Video Channel

5 Steps to addiction

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1

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

Drugs of addiction

Addiction.
Photo courtesy of Pixabay.com

What does it take to turn a normal person into a drug addict?

I remember some career information when I was in high school. We took a test to see what our abilities were and what careers might interest us the most. I don’t remember a drug addict or alcoholic being on the list of possible careers. Even without any guidance a lot of people end up making a lifetime occupation out of their addiction.

How does addiction develop? Take these five steps to find your chemical dependency.

1. Experimentation with substances.

Involvement with chemicals begins with some experimentation. A friend offers you one of their cigarettes and you try it. Forget all you have heard about this or that drug being a gateway drug. Far and away the “gateway” drugs of choice are nicotine and alcohol.

Lots of kids get their start at abusing drugs by swiping a few cigarettes, maybe a pack if they can, from a family member. A leftover beer, a partial bottle sitting around, that is all it takes. Lots of seasoned drug addicts remember with me the time they took some sips on a family member’s beer or drank from mom and dad’s liquor cabinet when the folks were away.

Boys usually get their start with the help and encouragement of a male friend or an older family member. It’s not a drug pusher that gets the disease of addiction going, it is a brother, uncle, cousin, or another close male.

Girls most often learn how to use drugs from their first boyfriend. They may go on to share this knowledge with other girlfriends but mostly they all compare notes and then get the next lesson from the next man in their life. Keep the learning up long enough and one of those men will teach you how to save money by sharing needles and then you can share everything that man has, especially the diseases.

2. Social drinking and drug use.

After the first trial of drug use, the budding young experimenter is likely to finds some collaborators in drug learning. The guys or gals get together and drink a few beers, sometimes they get wasted. Eventually, sooner probably, rather than later, someone brings some weed, bomb, some 420 to the party. The group has discovered marijuana; they have also discovered doing an illicit or illegal drug.

Some people have to steal the weed, others buy it, a few have “friends” who in the beginning will front it to you for free. This is probably too early in the trip for the aspiring popular person to have heard the old expression “the first one is free; the second will cost you double.”

Every week the group gets together. Say Friday night. Eventually given enough good stuff, the party stretches over into Saturday morning. There may be some getting drunk, some learning to throw up and to treat hangovers the next day.

There may be some violence, some unplanned, even unwanted sex. People may start doing illegal and dangerous things. Occasionally people get in trouble, get arrested, or even killed. Usually, that is someone else in some other town, someone who wasn’t careful enough. It won’t happen to one of your group.

As long as it is social it is all good. But what happens when the group is away?

3. Substance use becomes a habit.

The time will come in everyone’s life when the group is not there that one Friday night.
This is the turning point.

It is Friday. That is the night you drink and party right? Tonight you are alone. What will you do? This is the point where a few will decide enough is enough. A few beers with friends is fine, but this getting drunk and stoned every weekend is too much.

Far too many people at this point decide that it is Friday and on Fridays, we drink and drug. They will go on with the party, friends or no friends. They may look for another group to use with or they may use alone, but at this point, they have turned a social event into a habit. They will use no matter what it takes.

4. Psychological need for substances.

The user will struggle along for a while, months, years, maybe even decades. The use now is accelerating. There is more using alone. The negative consequences begin to mount up.

There may be DUI’s. When using they do things they will regret later. There are fights, violence, possibly arrests. They decide they want to quit. At this point, they have had enough. They vow to stop drinking and drugging, well not stop exactly, but they will cut back.

The person on their way to addiction is at the point where when they try to control their use they find it is so much harder than they thought. They have lost the ability to control their usage. They need to drink more and use more to get the same high. This is called tolerance. They can’t function without the drug.

In those brief periods of not using or drinking they can’t stop thinking about the drug, how long till five and the next time they can drink?

This person is not yet fully psychologically dependent but they have developed a mental need for their drug of choice. Without that drug, they are not happy. Even with the drug they are no longer enjoying the use. They now use just to get back to normal.

5. Physical need for a drug completes the process.

At this juncture, the person is having physical problems. They may get sick when without their drug of choice. They can’t stand the thought of running out. The alcoholic now needs an eye-opener in the morning. The meth addict tries to keep back a taste to help get them out of bed. It is no longer using to feel pleasure, now it is using to get well again.

The alcoholic may have D.T’s. They may risk seizures and death if deprived of their drug. The process has gone to the end. The experiment is over. The drug has taken control of the person.

If you recognize yourself in this story, consider where you are in the process and where you want to go. If you have reached the point where this is a habit or an addiction know that there is help available to stop the disease of addiction before you reach the end.

Beyond psychical addiction, so the story goes, there are three destinations, Jails, institutions, and death.
Changing the outcome is not easy but it is possible.

Are you ready to change your direction or are you on the 5 steps to addiction path?

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

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.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

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

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

For videos, see: Counselorssoapbox YouTube Video Channel