Which alcoholic beverage causes the most hangovers, DUI’s and damage to the body?

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

Liquor

Alcoholic beverages.
Photo courtesy of Pixabay.com

Standard drinks and why they matter.

There are more urban myths and legends around alcoholic beverages than you would find in most children’s storybooks.

People believe that one particular alcoholic beverage is safer or less likely to get you drunk than another. Does drinking shots get you drunk faster? Is wine safer than beer? Can you avoid becoming an alcoholic by sticking to beer and avoiding the hard stuff? Let’s look at the facts behind these beliefs.

All alcoholic beverages share one most significant ingredient – ethanol. Alcohol is produced by the action of yeast fermenting something. Fermenting grains and berries produces ethyl alcohol, which is the only alcohol that can be drunk by humans without fatal results. Wood can be fermented and produces methyl alcohol, but if it is drunk it can be fatal, producing blindness and brain damage before death.

All alcoholic beverages contain ethyl alcohol. When it comes to intoxication – alcohol is alcohol. What varies is the amount of alcohol and the various additives and flavorings. Make no mistake. The more ethyl alcohol you consume the drunker you will get.

To compare one alcoholic beverage with another we have created the concept of a “standard drink.” Correctly served, a standard drink of beer, wine, or a shot of hard liquor all contains precisely the same amount of alcohol.

Beer.

A standard drink of beer is a twelve-ounce bottle.  One small can of beer contains one standard drink. People mislead themselves into thinking that drinking beer is safer because it requires drinking more volume than other drinks to get the same blood alcohol level.

More than once a client has said: “I only had a couple of beers but I got a DUI anyway.” It makes a lot of difference if the beers were 12 ounces or 40 ounces. One beer should produce a blood alcohol level of about .02. Two 40 ounce beers are equal to almost 7 of the little ones and will produce a blood alcohol level of around 0.14.  That is past the point of legally drunk in most any place I know of.

It is also worth noting that in the United States of America more than half of all the alcohol (pure ethyl alcohol) consumed comes from beer. Lite Beers may be as bad or even worse.

Also for the record, your liver may develop tolerance to alcohol but the liver only has one speed. No matter how high the blood alcohol level goes the liver can only detoxify one standard drink of ethyl alcohol an hour and the liver only starts to work once the alcohol is digested and absorbed into the bloodstream. This explains why someone can drink a couple of 40-ounce beers, feel fine, and then suddenly feel drunk an hour to an hour and a half later after the alcohol gets absorbed into the bloodstream.

Malt liquor will get the drinker even higher blood alcohol numbers, up to half again the numbers for beer.

Wine.

A standard drink of wine is one – five-ounce glass of 12 % wine. This number will vary from text to text. Some places measure alcohol by volume and other countries measure by weight. So don’t be surprised if you read elsewhere that a standard drink is 4 ounces of wine.

If you like “fortified wines” as in sherry or port the size of the glass needs to be smaller. A standard drink of port is a 3.5-ounce glass.

It does not count if you open a bottle of wine, pour one glass, and then continue to refill the glass all evening. If you finish off the whole bottle of wine, regardless of the number of glasses you use, you will have consumed 5 standard drinks. Five standard drinks on one occasion for a man or four standard drinks for a woman is binge drinking and does a lot more damage to your body. This is an even bigger problem if you are a binge drinking senior citizen.

Shots – Hard Liquor.

A standard drink of hard liquor is one and one-half ounces of 40% alcohol. Since proof numbers are exactly double percentages that would mean a standard drink of 86 proof liquor should be just shy of 1 ½ oz.

So a person drinking 3 ounces of hard liquor in a small glass gets two standard drinks.

Question?

A beer drinker consumes a forty-ounce bottle of beer; his buddy drinks only one glass with three ounces of 86 proof tequila, who is drunker?

Easy – the beer drinker consumed like three and a half standard drinks, the tequila drinker only consumed two standard drinks, the beer drinker will be way more intoxicated come an hour later when the drink is absorbed into the bloodstream.

See how easy it is to fool yourselves saying you had only one drink when in fact there was a whole lot more alcohol in that one drink than you thought?

In this discussion, we have left out the effects of “tolerance” and “withdrawal” which complicate the math but not the legally drunk part. We also have not talked about drinking something stronger like “151” or “191” and how much closer that could take you to the .60 blood alcohol level where you blackout, organs stop working and you get pronounced legally dead.

Also, you need to know that if every time you drink, you end up drunk, which has less to do with the kind of drink you consumed and more to do with your having counteracted a disease called alcoholism.

So the results of this exercise tell us, it really doesn’t matter if you drink beer, wine, or hard liquor, what matters is how much ethyl alcohol is in that drink and what happens to you when you put ethyl alcohol in your bloodstream.

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

Binge drinking, memory loss, cognitive decline and Alzheimer’s

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

Drinking

Binge drinking.
Photo courtesy of Pixabay.com

Binge drinking your way to Memory loss, cognitive decline, and Alzheimer’s.

Once you get past age sixty-five, it doesn’t take much in the way of binge drinking to impair your cognitive abilities. A recent study by Dr. Lang of the University of Exeter reports that the threshold for memory loss as a result of binge drinking is a lot lower in senior citizens than previously thought.

Seniors who binge drank TWO times per MONTH were 250% more likely to have memory loss and cognitive decline than those who did not binge drink.

The study defined binge drinking in seniors as four or more drinks on one drinking occasion. Given what other studies have found about the declining tolerance of seniors for alcohol, that four drink figure sounds awfully high. See a previous post on binge drinking for more on the effects of substances on the elderly.

This study does not draw a conclusion about any connection between binge drinking and either dementia or Alzheimer’s. But the conclusion that even occasional episodes of four drinks by seniors can impair the memory makes me question the safety of these promotions trying to get seniors to drink a little for their heart.

This study was presented at the Alzheimer’s Association International Conference. A second study presented at the same conference examined the effects of “moderate” drinking on older women. In this one over 1,300 women age 65 and up were studied for twenty years. The result?

Moderate alcohol consumption did not protect memory in older women.

We also suspect that binge drinking coupled with prescription medications increases the risk of blackouts in Seniors.

The drinking by seniors conclusion?

Alcohol consumption by seniors does not protect the memory and even occasional binge drinking, as few as four drinks in one day, maybe less, can result in memory loss for those in the senior community.

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

Can you change a mentally ill family member – Powerlessness?

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

Change

Change.
Photo courtesy of Pixabay.com

What is powerlessness?

Does powerlessness have anything to do with mental illness and family members? The more we move from a model of mental illness that emphasizes permanent disability to a wellness and recovery model the more we see terms like powerlessness applied to the recovery from mental illness process. One blog reader asked about applying Al-anon principles to their problems with mentally ill family members.

Are people really powerless over mental illness and addiction? Doesn’t saying you are powerless just breed an attitude of helplessness, a victim mentality? Not at all.

There are some things in life we have control over, there are a lot of other things that we have little or no control over. The important thing is learning which is which.

This kid was walking along texting on his phone and generally not watching where he was going. He walked straight into a cement wall. The whole situation looked humorous to me, but I am quite sure it was not a laughing matter to that teen. He became quite angry and hit that wall a good one with his fist.

That teen could stand there pounding away at the cement wall but in the end, he is likely to find he is powerless over that wall. Eventually, he may damage the wall but he is going to harm himself seriously in the process.

Now insisting that the wall is wrong, that it needs to get out of his way is unlikely to be helpful. But isn’t that what happens to so many people, especially people in recovery, every day. Despite clear indications that the current approach we are taking is not working we continue to insist that the world change to accommodate us.

Looking at that wall in an objective way it was easy to see that there was a gate only a short distance away. The teen could have taken the gate, or at the other end the wall ended and with a few extra steps he could have gone around, still, he insisted the wall change.

The alcoholic is like that. Every time they drink they end up drunk. They struggle to control their drinking. The anxious or depressed person tries to deny they have a problem. Ignore the problem and it will go away is the universal motto.

Even after untold negative consequences, alcoholics tell themselves they will find a way to keep drinking and not have problems. The sad truth is that if anything has become an addiction in your life you will never be able to control that thing again. You are powerless to make that thing do what you want it to.

We are all powerless over rain. Now anyone can take a few raindrops. But I have never been able to make it rain or not rain on command. Facing a hurricane I can walk into the storm contending that I am not powerless over a little rain but eventually the storm will get the better of me.

The surest course of action when encountering the hurricane is to admit you are powerless over the storm and take cover in as safe a place as possible. Accepting that you are powerless over hurricanes and that the storm will do what it will do is a wise use of thought. Accepting help for your emotional problem is a wise course also.

The safest thing to do when encountering a drug is to admit that the tiny little thing can whip you any day. Struggling to do a little of the drug and still not let it control you is looking for disaster. No one controls their addiction. Learning that you can say no before the first taste, that is power.

We also need to learn that we are powerless over others. All that begging and bribing, the threatening and the use of force, this approach never really gets you control of the person. If your partner is addicted do you really think you can somehow win the battle to control the substance? We are powerless over people and things.

People will struggle for years to not be sick even when an effective treatment for their problem is right in front of them.

So the idea that a family member might by some special effort get their family member to change and presumably not have a mental illness, that is the clearest sort of delusion.

A central message of Al-anon as I understand it is the same as the message to addict’s, continued efforts to pretend that we have control over others, people, or things, are an illusion. Once you admit you are powerless over the mental illness, then the person can stop trying to pretend they don’t have the problem and begin to look for help in living with their issue.

The key to helping others is to first change yourself. The serenity prayer tells us to change the things we can, mostly that is ourselves, accept the things we cannot change, and develop the wisdom to know the difference.

Absolutely spiritual principles like those of A.A., Al-anon, and other 12 step groups apply to mental illness just as they apply to addiction and 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

Dangers of Binge Drinking

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

Drinking

Binge drinking.
Photo courtesy of Pixabay.com

Binge drinking may be more dangerous than we thought.

One drink per day for thirty days, for many people this is no big problem. No drinks for thirty days and then binge drink thirty drinks in one day, that would be a huge, maybe fatal, problem.

Thirty drinks, if consumed rapidly enough and kept down would result in a “theoretical” blood alcohol level of .60 which is enough alcohol in one person to have made seven and a half people legally drunk. At that blood alcohol level, the person would probably not need treatment. They would already be dead.

Blood alcohol levels of .50 to .60 are likely to be fatal. But even lower levels can kill or permanently injure a person. Alcohol kills more people in the United States every year than ALL DRUGS, legal or illegal combined (not counting nicotine.) Even when people die from other drugs, they typically have alcohol in their bloodstream.

To be fair, not everyone who drinks, binge drinks, and gets drunk. About half of all Americans old enough to drink have not had a drink in the last thirty days. Those who drink a lot, damage themselves and others a lot.

The twenty percent of Americans who consume the most alcohol, the frequent binge drinkers, consume 80% of all the alcohol sold. The majority of all the people in prison around here were drunk or high in the 24 hours before they committed the crime that sent them to prison.

People who drink rapidly and reach high blood alcohol levels are likely to have blackouts.

Even at much lower levels, we find that “binge drinkers,” those who consume larger than typical amounts of alcohol on one occasion, are 55 times more likely to attempt suicide.

The damage alcohol does to the body depends on the level of alcohol in the bloodstream. Our way of assessing risk, based on the number of drinks during a single “drinking episode” is biased towards underestimating the extent of binge drinking. Not everyone who drinks gets the same result.

The blood alcohol level is dependent on a number of factors and the number of drinks is only one of those factors.

Body weight influences blood alcohol levels. If a one hundred pound person and a two hundred pound person have the same number of “standard drinks” the one hundred pound person will have a significantly higher blood alcohol level.

Alcohol is soluble in water, the more water in the system the lower the blood alcohol level. Men have more water per pound of weight than women. This means that if a man and a woman of the same weight drink the same amount of alcohol the woman ends up with a higher blood alcohol level.

Liver function also affects the body’s ability to process alcohol. A damaged liver and the drink will stay in your system longer.

Age is a factor. You can put color on your hair but you can’t pretty up your liver. As you age the liver gets old and tired. It won’t process as much alcohol per hour. An old liver will result in higher blood alcohol levels. Studies tell us that the “safe” level of alcohol consumption for an “older person” is maybe half what it was for a younger person.

If one glass of wine a day is good for you at age 30, three glasses a week will be your max at age 80 or so. I know there are exceptions, don’t email about your grandparent who still drinks a tall one every day and is in good health. Studies say that for the elderly, most of them, 3 drinks a week would be all that is safe.

Binge drinking is defined as 4 drinks on one drinking occasion for a woman and five drinks for a man. We have already underscored that for people of low body weight or the elderly or woman these numbers are way too high.

Who is at the highest risk for medical problems from binge drinking? Four groups are at highest risk, the young, the old, the pregnant, and the alcoholic.

The young have more drinking problems.

They don’t know the risks and the results. They can get drunk, hurt someone, be in trouble and there goes the life. Almost all people with a substance use disorder become alcoholics or addicts before the end of their twenties.

The elderly have lots of substance use problems.

These folks are not exempt. In more than half of all hospital emergency room admissions of senior citizens, the elderly person is drunk or high when the accident occurs. One reason seniors are falling down and breaking hips is they are stoned.

Seniors may become depressed when they retire or end up living alone. They may drink; take prescription drugs and even illicit drugs. Put that all together and it is easy to have substance abuse get out of control in the elderly.

The pregnant should not drink.

Any alcohol is bad for the developing fetus, the more alcohol the worse the damage. We can’t always see the damage as it can hide in lower IQs, retardation, and learning disabilities. Alcohol induces “Fetal Alcohol Spectrum Disorder” which is the largest source of preventable birth defects.

The alcoholic will not be able to safely drink.

As many an alcoholic will tell you “one is too many and a thousand is never enough.” The hallmark of alcoholism is the loss of control. An alcoholic has lost control of how much they will drink once they get started. The only “safe amount” for someone with a history of alcoholism to drink is – none.

Many drug addicts get into recovery and then fool themselves by thinking “I never had a problem with alcohol so I can drink safely.” Scratch a drug addict and you will find an alcoholic. The same seems to hold true for anyone who has had any other form of impulse control problem.

Consider for a moment. If you drink multiple drinks, most days or end up drunk when you drink you may have a drinking problem. If you binge drink, drink with the intent to get drunk or buzzed, you are in the highest risk group.

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

Anxiety – fears and phobias can be treated.

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

Fear

Get rid of fear.
Photo courtesy of Pixabay.com

Are you afraid of spiders, snakes, or public speaking?

If you are afraid of a particular thing or situation and go to lengths to avoid that thing you may well have a Specific Phobia. Specific Phobia involves the fear that a particular thing is going to harm you. This fear may be irrationally strong even when you have never been harmed this way before and the risk is low.

There are five types of specific phobias, Animal type, Natural environment type, medical type, places, and “other” type. Other type includes diverse things like a fear of choking and a fear of costumed characters. People with a specific phobia, except very young children, know their fear is excessive and is interfering with their life but they will go to great lengths to avoid the thing that scares them and to avoid getting treatment for their phobia.

Animal type refers to the spiders and snakes as well as any number of other creatures great and small that may scare us. Some animals may really be harmful or dangerous but a phobia is not restricted to only those things we should fear but is enlarged to fear all creatures whether they are likely to harm us or not.

Natural environment phobias include heights, weather, and water. The “medical type” includes such things as blood, needles, and medical procedures. Place phobia is best known for fear of flying and elevator fear.

A closely related anxiety disorder “Social Phobia” includes things like public speaking and eating in public. In social phobia, the fear is not of being physically injured but a fear of doing something that is embarrassing or uncontrollable.

Both social phobia and specific phobia are treatable. For some people, medication can help to manage symptoms in the short run but over time the symptoms of anxiety may reappear. A specific counseling method called systematic desensitization or exposure therapy is especially helpful for treating specific phobia and a related method works well for fear of public speaking.

If the phobia becomes excessive someone may seek treatment. Here is an example of a treatment episode for a mother; we shall call Ellen, who had a terrible fear of snakes. She was practically pushed in the office door by her husband Bob. Her son and her husband Bob both wanted to go camping and she had refused. While on vacation they had wanted to visit a zoo. Both of these activities might involve snakes and snakes terrified Ellen.

The therapist began by teaching Ellen how to relax using deep breathing and other relaxation techniques. It is impossible to be both frightened and relaxed at the same time. Over the next week, Ellen practiced her relaxation methods every time she became anxious, whether it was about snakes or just day-to-day life.

At the second session, they discussed what things about snakes provoked what level of fear. Could Ellen write the word snake on a piece of paper with only modest fear? Could she say “S-N-A-K-E.?”

For each item on the list, they assigned a number from one to ten. The goal was, to begin with, the “snake’ exposures that were the least frightening and progress to the more threatening ones. Her fear hierarchy might come out something like this.

  1. Write the word snake on a piece of paper.
  2. Say snake.
  3. Talk about snakes.
  4. Read a word book about snakes.
  5. Look at pictures in a book about snakes.
  6. Watch a video about snakes on T. V.
  7. Visit a local pet store with her son and look at snakes in the cages.
  8. Touch a snake while the pet shop owner held him.
  9. Visit the local zoo and look at snakes in the Herpetarium with her son and husband.
  10. Go on a camping trip where they might encounter a snake.

After developing the “snake fear scale” Ellen practiced her relaxation. She was then able to write down the list of “snake steps” and read them back to the counselor at the second meeting.

By the third session she was reading an article the counselor had brought in about types of snakes and some of the good things snakes can do.

Her efforts to look at pictures in a book took longer, several times she had to stop, do her relaxation exercises, and discuss her feelings with her therapist.

Ellen watched the snake video in the counselor’s office, being prompted to do her breathing and relaxation as needed. She was able to take the video home and watch it a second time with her family and reported it went well and she did not have to close her eyes even once.

By the time summer came Ellen reported to the counselor she had completed steps one to nine.

This same sort of method can be used for social phobia. A common fear is public speaking. Many people report they are more afraid of public speaking than death. The old approach to fears and phobias was the “throw them in the deep end and they will sink or swim.”  Too many people were traumatized by that approach and never went into the water again.

Turns out that Bob, (Ellen’s husband remember?) was not afraid of snakes, but he was terrified of speaking in public. His company wanted him to make a presentation later in the year at a large convention and Bob was terrified. The counselor worked with Bob for a while on relaxation techniques and then gave Bob some choices.

For those with a fear of speaking there are classes at the local college or adult education and there are clubs whose purpose is to help people overcome their fear of speaking in front of others. Working with a small group of others who are all trying to learn to speak in public can ease the tension. Building up gradually from talking around a table to standing up and speaking to the group and finally to speaking in front of progressively larger audiences can build your confidence.

Bob took the college classes. He was able to complete the class and began speaking to groups his company sent him to speak at. Things were going fine. – Sort of.

Then the counselor got a frantic call from Bob and Ellen. Despite all their efforts and all that progress, Bob was terrified of the speech he needed to give at the convention, he was thinking of quitting his job to avoid it. Ellen had been in the bedroom crying for the last week. She was not going to the convention with Bob, as much as she wanted to be supportive because that meant the camping trip after the convention and her fear of snakes had returned with a vengeance.

Why after all that work had Bob and Ellen had a relapse of Anxiety? We know systematic desensitization works to reduce anxiety.

Stay tuned for a post on what causes an anxiety relapse.

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

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Is everyone Bipolar?

Posted on by
1

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

Person with masks

Bipolar.
Photo courtesy of Pixabay.com

Just how common is Bipolar Disorder?

There are people out there with Bipolar Disorder as we currently understand Bipolar. Some people who really have this issue never get diagnosed and miss out on the treatment they need. From some of the things on the web today it is hard to see how anyone could escape getting this diagnosis. For more on this dilemma see the post, Bipolar – Misdiagnosed or missing diagnosis?

If professionals give out a diagnosis too freely then it stops having any meaning. So just how common is Bipolar Disorder and what should we think about people who sort of have it?

Some perspective

Humans are not the only creatures on earth who act “bipolar.”

Think about some of the symptoms. Elevated expansive mood, reduced need for sleep, increased impulsivity and heightened sexuality. Hum—

It is hot here now, but only a few weeks ago it was spring. From the window in my office, I watch the birds in the trees and on the lawn. There are a lot of native doves in my immediate area. For a while, just after Valentine’s Day, those doves woke me up in the morning. They were cooing constantly and then mating – can’t describe that and stay P. G. rated. When pursuing and being pursued by mates their temperament can best be described as irritable. Are doves Bipolar? Are they only Bipolar in the spring time?

Every spring the days start getting longer, the creatures on planet earth respond by becoming more active, they and we humans with them, think about reproduction. If birds breed in February they have babies by Easter. Humans seem to breed just as fast but we take longer to get the babies done.

Then in the fall time, the doves seem to disappear. So do the humans on my block. All those exercise freaks stay indoors. As the days get shorter the mood among humans gets gloomier. This may be one reason we have so many holidays in the fall and winter, Halloween, American Thanksgiving, Christmas and New Years all in a couple of months. We do this to cheer ourselves up. We also see extra depression during those months of less light.

If birds are affected by the changes in weather, humans are affected, and other animals also, it is difficult to go on describing these mood fluctuations as a mental illness.

We know that some people are affected by the seasons more than others. The degree and magnitude of mania and depression vary from one person to another. When have we crossed the line and turned normal human emotions and feeling into a pathological disorder?

There are also milder variations in human behavior we call “personality.” Talking about personality types, wondering why we are the way we are, is an interesting study. One needs to be careful in learning about personality to not make the first year student mistake and start seeing pathology where none exists. Not everyone who is moody, sleepless, irritable, or extra sexual needs to be diagnosed and put on medication.

As a therapist, I know there are lots of folks who would benefit from talking to a counselor about their problems. We also know that insurance wants us to be sure they are mentally ill and meet the criteria for “medical necessity” before insurance pays for the treatment. The challenge is to stick to the criteria and make sure only people with a real mental illness get treated using insurance money, while still trying to help all the people we can. Professionals continue to debate exactly where the lines of a disorder should be drawn.

At this point, we have three for sure reasons why someone’s symptoms get severe enough that they get the diagnosis.

1. Your issue interferes with “occupational functioning,” which includes school, for children and volunteer work if you are disabled.

2. It interferes with “social functioning” which mainly means you have poor or no relationship with family and friends.

3. Your issue causes you “subjective distress,” meaning a whole lot of emotional pain.

Having a personality that is not as you would like it may be painful but I hesitate to throw that in with mental illness. So if you are too introverted, impulsive or have some such personality trait, you can work on that, but you are not likely to be severely enough impaired to be diagnosed with a mental illness.

Some people may have “bipolar trait” or a “bipolar temperament” these are things you may or may not choose to work on in yourself improvement projects. “Hyperthymic Temperament” and Hyperthymic Personality Disorder” is just such a condition. Hyperthymic Personality Disorder is a common name NOT a specific diagnosis. DSM Personality Disorders are far more severe than Hyperthymia.

My thinking is that if you have characteristics like this you may want to consider being screened by a profession and keep an eye out for the possible development of Bipolar Disorder.

One thing we professionals should avoid doing is turning everyone who is different, into a pathological condition.

So is everyone Bipolar? The DSM-4 reports that the prevalence of Bipolar I and Bipolar II combined is more or less 2%.  Irritable, moody, impulsive and sexual people – that is just about all of us.

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. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

Do people really forget what happened when drinking? – Blackouts

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22

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

Liquor

Alcoholic beverages.
Photo courtesy of Pixabay.com

Memory, Blackouts, Alcohol, and Drugs.

Alcohol and other drugs can impair memory in a number of ways. Alcoholics frequently say they can’t remember what happened while drinking. People who have never had a blackout question if the drinker really can’t remember, or do they just not want to take responsibility for their actions. Both are possible. Alcohol is not the only reason someone might do something and then have no memory of the occurrence. Consider the following examples.

Let’s say that the people in one of the classes I taught all became very close and the group decides they would like to have a celebration after the last session. We decide on a pizza party. We get out the phone book and look up the number. We are all old school, imagine the days before cell phone Apps. I read off the number and one of the students runs downstairs to make the call. In this building, there is almost no cell phone reception.

When they return I ask “Did you order soda?” They tell me they didn’t.  Well, we need something to drink with the pizza so go call and add some soda to the order. The students reply?

What was the number?

Why can’t they remember that number?

Now I just gave them the number why can’t they remember it?

Many things in life are held in short-term memory only as long as needed. Once the need for the information is gone the memory is discarded. You may remember what you ate for breakfast today but not many people could report what they had for breakfast all of the last 365 days. Even if they had the same thing every day they would not be able to tell me which day was better or worse.

Alcohol interrupts the transfer of information from current working memory to long-term memory. Since the memory could not be saved there is no memory remaining. Ever turn off a computer or close a file and then realize you hadn’t saved the work? Computers have programs to ask you if you want to save that, otherwise, we would lose a lot of work.

Cell phone designers had to include this factor in the design. They know that phone owners will want to call people back and that the human brain will not remember the number even if you just dialed it a minute ago. The phone holds the memory for you.

Blackouts are most likely to occur when the blood alcohol level rises rapidly. A few sips an hour, no blackout. Knock down the whole fifth in a couple of minutes and the rest of the night may be gone.

Blackouts are not the only reason alcohol and other drugs may alter memories.

State-dependent learning.

Consider this scenario. Someone goes to a cocktail party. During the night they talk with a lot of people, exchange some business cards, and generally have a good productive time networking. Only they also drink too much.

Next morning they find the business cards in their pocket, only they can’t remember who these people were or what they talked about. They weren’t drunk enough to have a blackout but they did talk to a lot of people. Why can’t they remember these people?

Later in the day, they go to lunch, say they have drinks with lunch, nothing huge, just one or two drinks. They go for something in their pocket and there are those pesky cards. And suddenly they remember who these people were and what they talked about.

This is called state-dependent learning.

Information is filed away in the brain but it is as if there are file cabinet drawers for memories that are only needed in certain situations. One file drawer is for things to remember while intoxicated. These memories are harder or impossible to find unless drunk.

Students who pull all-nighters to study for finals and use lots of chemicals to stay awake may have the same result. The brain puts those memories in a drawer labeled only needed when high on stimulants. Next day in class they forget everything they studied. The lack of sleep didn’t help either. Two weeks later over some espresso, they remember something they needed for the final.

This is also why some things just can’t be learned in a classroom. Swimming and diving are examples of this. All the classroom time in the world and suddenly when you are in the water everything changes. State-dependent learning can involve things other than alcohol or drugs. Internal states, like hunger and thirst, and external states like places and activates can affect your ability to remember things.

In addition to blackouts and state-dependent learning, there are several other ways in which alcohol and drugs may be affecting memory.

Poor physical and mental health impairs memory.

When you are depressed or overtired, things may not stick in your memory. Over time there can be physical and chemical changes in the brain. Alcoholic’s brains shrink. Some drugs kill or damage nerve cells. Aging and normal memory loss may also be accelerated by substance abuse.

Memory also has a situational component. I use multiple computers at multiple locations. They each have different passwords. When at one office I will remember the password for that office and automatically enter it. Most of these passwords have to be changed every month. Last month I thought why not use the same password I just entered at the other office this morning? I could not remember it. The next day back at the first office I entered that new password without a thought and then realized, I remember passwords by the surroundings.

Doorway effect on memory.

The “doorway effect” also is likely to be more pronounced when you abuse substances. Doorway effect is the phenomenon of moving through a doorway, going from my home office to the kitchen for some water, and when I get to the kitchen I can’t remember why I am there. This confusion and the available food may explain that mysterious weight gain. This is a normal occurrence for people who do not do drugs but my experience working in substance abuse programs suggests that substance abusers are more likely to find their memories erased by moving from one place to another.

There are some thoughts on blackouts, state-dependent learning, situational memory, and the doorway effect coupled with the effects of drugs and alcohol on memories.

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 is double depression?

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

Depressed person

Depression.
Photo courtesy of Pixabay.com

Double Depression – Morning Question #12.

Double Depression is a common term, not a recognized mental health diagnosis. In Double Depression, someone who has Dysthymia, profound sadness, and depressed mood which does not quite meet the criteria for Major Depressive Disorder moves from a little sad and depressed to a lot sad and depressed. They develop a case of Major Depressive Disorder superimposed upon the Dysthymia. People with this condition may see the Major Depression respond to treatment but they are still generally sad. Continued treatment for the Dysthymia is recommended.

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

Degree but can’t find a job.

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3

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

Filling out a job application

Job application.
Photo courtesy of Pixabay.com

You got a degree but you still haven’t gotten a job.

Why did this happen and what can you do? Unfortunately, there are more and more people in this boat these days. When the economy turns down, lots of people return to school to get an advanced degree. Student loan debt is moving ever higher.

Just because you get that new degree does not mean you are going to get a job. In some majors, less than half of the people who received the degree ever found a job in their major field. One study found that ten years after graduation as many as 10% of graduates from a major prestigious college still had not found a job.

Many, but not all of the better-paying jobs available today require an advanced degree but there are plenty of college graduates who are unemployed. Why the mismatch?

Finding a job is a separate skill from what you learned in obtaining your degree.

Many college graduates became technically proficient in a narrow skill but they have little or no skills in interviewing. Lots of people want to work in a technical field because they are more comfortable around things than people.

Then when they look for work they find they don’t have the people skills to be able to work in a company. Career counseling can help with this issue. Go to groups and meet people, learn to network. Networking has two advantages, it helps you find job openings to apply for and it may improve your people skills so that you land a job after your interview.

There may be no jobs for your specialty in the area you are planning to live.

Until very recently California did not license professional counselors. Students majored in those areas because that was what they wanted to do. Then they discovered that to pursue this goal they would need to leave the state and move away from family, friends, and social networks. Some chose to go and some stayed and worked in fields unrelated to their degree.

Jobs that are only, sort of related to your major, may not pay what you had expected and you may not be able to maintain your skills if you work outside your degree area. It pays to think about possible job openings and do the research before you graduate. Sometimes even well into your college program, it is worthwhile changing your major or adding a minor in a related field.

Some people may be majoring in a field in which there are few jobs.

This is especially problematic in fields that people enter for emotional rather than monetary reasons. There are way more photography majors than paying jobs for photographers. Most photographers go into business for themselves only to find they should have majored in business, not photography if they want to make a living.  Technical schools and private colleges have been especially at fault here. They develop programs that sound appealing in the ads, but the number of students they are teaching far exceeds the available jobs.

What you learn to get a degree and what you do on the job may be very different.

Teaching is a good example of this. The course of study is about how to be a good and effective teacher. The reality is getting along with parents and administrators and trying to keep discipline in the classroom. Lots of teaching students complain that the reality is more like being a babysitter than an educator.  Before you commit years of study and tens of thousands of dollars to getting a degree consider learning more about what people with that degree actually do. Research working conditions, and job satisfaction. What you see people doing on T. V. is not what most people in that field do most of the time. Interviewing people who are actually working in that career is helpful. Many will be glad to share their experiences with someone who cares enough to ask. Especially ask them, “If you had it to do over would you do something else? Why?”

The narrower the specialty the faster the field changes.

The more specialized the field the more likely that you will need to stay in school or return often to stay current. The computer field has provided lots of examples of this. I know of someone who went to school to become a keypunch operator, computers used to need large trays of punch cards to tell them what to do. By the time this person graduated, the companies in their town were doing away with punch cards. Unless your school and instructor are cutting edge it is possible that even with a degree the firm that hires you will need to retrain you on their equipment and process. More on the retraining issue in the post about Cordwainers and Redsmiths.

Have a realistic expectation for salary; know what salary you should expect.

More than one person I have met has returned to school and gotten a new degree to make a career change only to find that they can’t afford to give up their present job and start over at the entry-level salary that the new field would offer. Do your research on salary and market conditions for a given field before you start and you will be more likely to be satisfied afterward. Monitor the job market while in school and be prepared to take some extra classes or adjust your program if the career field is changing. Salary should not be your only consideration. People who do things they love are happier, more productive, and often more successful than people who are unsatisfied with the job. But make sure you can afford to live on the salary you will get for a given job before you are locked in. Otherwise, you may have a degree in one field and work at something totally different.

The more advanced the degree, the higher the pay the longer it may take to find a job.

Especially if you are limited geographically or because of a narrow specialization. Many recent college graduates expect to find a new job right away. In this economy that rarely happens. Even in good times, it takes longer to find a job that requires and pays for a master’s degree than if you have a two-year or four-year degree. Finding a position if you have a Ph.D. will probably take even longer. The conclusion? A degree by itself will not be enough to get you that good-paying job. Do your research before, during, and after your college experience. Develop job search and interviewing skills in addition to your technical skills. Especially work on people skills, anywhere you go there will be people you need to work for and with. Develop other skills to allow you to use your skills, become better at communicating and expressing your thoughts. Have patience but continue looking and don’t give up.

Best wishes on finding that dream job.

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 an adjustment disorder produce depression and mania?

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2

By David Joel Miller MS Licensed Therapist & Licensed Counselor.

Depressed person

Depression.
Photo courtesy of Pixabay.com

Morning Question #11 adjustment disorder, depression, and mania.

Adjustment Disorder is essentially an excessive reaction to a normal stressor. The DSM-4 currently lists 6 types of adjustment disorders. They all involve some combination of anxiety, depressed mood, or behavioral problems.

Once the reaction to the stressor becomes enough to cause symptoms of a Major Depressive Disorder that is what gets diagnosed. If there is any mania or hypomania, that would become a Bipolar Disorder.

Stress can trigger all sorts of mental health issues. Someone with a history of depression or mania or an underlying risk factor like family history could have an episode under stress.

So rather than adjustment disorder producing depression & mania, stress could cause any one of the three.

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