Tolerance.

Sunday Inspiration.     Post by David Joel Miller.

Tolerance.

Tolerance.

Tolerance.
Photo courtesy of Pixabay.com

“What is objectionable, what is dangerous about extremists is not that they are extreme, but that they are intolerant. The evil is not what they say about their cause, but what they say about their opponents.”

― Robert F. Kennedy

“The highest result of education is tolerance”

― Helen Keller

“In order to have faith in his own path, he does not need to prove that someone else’s path is wrong.”

― Paulo Coelho, Warrior of the Light

Wanted to share some inspirational quotes with you.  Today seemed like a good time to do this. If any of these quotes strike a chord with you, please share them.

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Respect.

Sunday Inspiration.     Post by David Joel Miller.

Honor Guard.

Respect.
Photo courtesy of Pixabay.com

Respect.

“What is objectionable, what is dangerous about extremists is not that they are extreme, but that they are intolerant. The evil is not what they say about their cause, but what they say about their opponents.”

― Robert F. Kennedy

“I speak to everyone in the same way, whether he is the garbage man or the president of the university.”

― Albert Einstein

“Respect yourself and others will respect you.”

― Confucius, Sayings of Confucius

Wanted to share some inspirational quotes with you.  Today seemed like a good time to do this. If any of these quotes strike a chord with you, please share them.

What is selective tolerance?

By David Joel Miller.

Not all tolerance is created equal

What is tolerance?

Alcohol

Alcohol

Tolerance, as it applies to medications and drugs, is having less and less of a reaction to a drug the more it is used or having to use increasing amounts of the drug to get the same result. Tolerance, in the sense in which I am using the term here, is the way in which repeated exposures to something produce less and less of a reaction. People get used to things and so does your physical body.

When it comes to substances, whether they are legal, prescribed or street drugs, tolerance is that characteristic of the body to learn to resist things. The body develops an “immunity” or reacts less and less strongly the more times it experiences something.

Over time the drug addict uses more and more of their particular drug of choice. The person taking prescribed medications may also develop a tolerance resulting in needing a larger dose to achieve the same result or eventually they may need to be switched to a different drug.

Tolerance used to be one of the two symptoms that were used to define addiction. Withdrawal was the other one. Because tolerance and withdrawal are characteristics of many substances, not just drugs of abuse, we have had to look at other symptoms to define a problematic use of substances. We now call that problematic use a “substance use disorder.”

What is selective tolerance?

Selective tolerance is those times when someone develops a tolerance to one effect of the drug but not another. The body “selects” one action to develop tolerance to and not another.

A simple example of selective tolerance.

Coffee contains caffeine, a stimulant drug. Many people drink it first thing in the morning to help them wake up and get going. It is also common to find that consuming a caffeinated beverage to late in the evening results in not being able to sleep well that night. It is recommended that you not consume caffeine in the afternoon or evening so that you will get a full night’s sleep.

Have you ever known someone who could drink a lot of coffee or caffeinated soda just before bedtime and still sleep like a rock? Most of us have. That person has “built up a tolerance” to caffeine’s sleep interfering characteristic.

That same person will have some caffeine, probably a lot of it, the next morning and report that the caffeine helps them wake up and get going.

How can this be? Did they develop a tolerance to caffeine or not?

It appears that they have developed a tolerance to one action of the caffeine but not the other. That is the thing we call selective tolerance.

It is quite possible that psychological factors play a role here, but there are lots of other times when someone develops a tolerance to one of a drug’s effects and not another.

There have been some divided opinions on whether drinking coffee is good or bad. My belief is that for most people, most of the time, coffee has more positive than negatives. The choices it up to you.

Could you develop selective tolerance to the effects of alcohol?

The research says that many people do just that. This may be why we see very inconsistent results in research on some of alcohol’s effects. I am not being an apologist for alcohol by saying this, just trying to get the story right. Despite the problems, alcohol causes our society another round of prohibition is unlikely.

My view is that those countries that have a total ban on alcohol often have high levels of problems with another drug. Many countries with a total ban on alcohol have a worse problem than the U. S. does when it comes to Heroin. The solution, such as it is, seems to be better education on the effects of drugs on the mind and the body. Hence this blog.

Heavy alcohol drinkers develop tolerance to alcohol’s motor coordination effects.

Those who drink a lot find ways to hide the fact that they are under the influence. More concentration on walking straight may keep the drunk out of jail.  Research shows that many heavy drinkers do develop a tolerance to the motor coordination effects.

Heavy drinkers do not develop a tolerance to the bad decision-making effects

One key result of alcohol’s effects on the brain is disinhibiting the drinker. Under the influence, people say and do things that they would not do when sober. One study reported that they found no tolerance developing to alcohol’s disinhibiting effects in heavy drinkers (Miller, M., et al, 2012, no relation to me I know of.)

This study also notes that recent drinking patterns are predictive of tolerance. You do not need to be an alcoholic, a chronic drinker or even a heavy life time user of alcohol to show a tolerance to some of its effects.

So we conclude that people do develop selective tolerance to the effects of alcohol and probably most other drugs. Drinking a lot of alcohol is still not a good idea. While your liver may develop tolerance with repeated doses of alcohol, it can also develop Fatty liver, alcoholic hepatitis, and cirrhosis.

Use all medications and drugs with caution and be aware that while you may be developing some tolerance, getting used to using this drug, there are probably other effects the drug is having on your body and your mind that you are unaware of.

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Get the latest updates on my books, due out later this year by signing up for my newsletter. Newsletter subscribers will also be notified about live training opportunities and free or discounted books. Sign up here – 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 the about the author page. For information about my other writing work beyond this blog check out my Google+ page or the Facebook author’s page, up under David Joel Miller. Posts to the “books, trainings, and classes” category will tell you about those activities. If you are in the Fresno California area, information about my private practice is at counselorfresno.com. A list of books I have read and can recommend is over at http://www.counselorfresno.com/recommended-books/

What is an addiction?

By David Joel Miller

How many addictions are there?

Addiction

Addiction

More and more things seem to be getting labeled as addictions.  This mushrooming of addictions has resulted in a lot of skepticism about whether all these items are really addictions or just excuses by people who do too much of one thing or another.

The mental health professions don’t typically use the word addiction. We use other terms to help explain why what is commonly called an addiction may look so different in different people.

Let’s explore this problem by starting with the best known of all addictions, drug addiction and then see what other things might qualify as addictions.

Drug addiction.

Most drugs, legal and illegal, result in two specific reactions in the body, tolerance, and withdrawal. Tolerance means that over time your body builds up a resistance to the drug so that it takes more and more of the same drug to get the same effect.

Physically addicting drugs all result in tolerance in the body.

Withdrawal is the phenomenon of symptoms that occur when the level of the drug in the bloodstream begins to drop. As many an alcoholic knows if you can keep the level of alcohol in the bloodstream up, you can hold off the hangover for a while. Eventually, you fall asleep or more precisely pass out, and then the blood alcohol level drops.

The drop in the level of drug in the bloodstream, not the absolute level is what is causing the withdrawal symptoms, sometimes also referred to as “abstinence syndrome.”

When someone has been abusing drugs, including alcohol, we take them to a detox. They go through a lot of symptoms, some very unpleasant, as the drugs leave their system. So after 3 days or so, defiantly in a week, most all drugs (except marijuana) are out of the system.

The carvings problem.

No drug (alcohol) in the system, the hangover or other withdrawal symptoms go away. In the case of heroin, the shakes, diarrhea, vomiting, goosebumps, and all the other classic symptoms of opiate withdrawal end and the person, now with no detectable drugs in their system are discharged to go home.

The majority of all people who go through detox, somewhere over 90%, will relapse or use again in a month or so after the detox.

If the drugs are all out of their system why are they still exhibiting addictive behaviors?

The problem with addiction is not the chemical dependency in the body, as awful as that can be. The real problem of addiction is that it is a problem of the mind.

We might call this manifestation of addiction a psychological dependency on the drug to differentiate it from a physical addiction. Even when no drugs are in the body the cravings remain in the brain.

Behavioral addictions.

So can people really be addicted to things like shopping, sex or compulsive spending?

My belief is that these kinds of activities can also be addicting but are not automatically addiction.

Each activity produces thoughts, those thoughts move through the brain chemically. Change your thinking and your brain chemistry changes. Some experiences, falling in love, having sex, can produce chemical changes in the brain that can be like an addiction.

One key criterion for addiction is the loss of control, if you lose control of an activity you are approaching addiction land.

Continued use of a substance or continued repetition of a behavior despite negative consequences, loss of control over a behavior fit this pattern.

Hypothetical example.

A client says she is “addicted to poodles.” She has poodle skirts, poodle statues, and pictures all over her house. Her husband gripes about all these poodle things but they are still together after 25 years. She says she is “addicted to poodles.” I think she has an unusually large interest, even an obsession with poodles, but so far it does not sound like an addiction.

Let’s say she also has 25 live poodles in the one room apartment and that she has spent all of their money on poodle stuff this month leaving them with no money for rent and food. Now has her poodle addiction crossed the line?

So while excessive involvement in many things might possibly reach the level of being an addiction the more strongly rewarding things like drugs, alcohol, sex or risk taking (gambling) produce such high levels of chemicals in the brain that many people might become “Addicted” to these behaviors. Most people are not likely to develop an addiction to poodles. The internet on the other hand –

Let’s leave that for now.

So in many ways, I see addiction, to drugs or other things, as a special case of OCD. The person can’t stop thinking about the object of their addiction and with chemicals or behaviors like gambling once they start they lose control over the substance or the activity.

Most recently we are recognizing that it is possible to have a problem with a chemical or behavior way short of developing an addiction. We might call this a “Use Disorder” or with behaviors we might think of it as an impulse control problem.

However you see this, loss of control over a chemical or an activity can cause someone a lot of life problems and needs treatment.

Want to sign up for my mailing list?

Get the latest updates on my books, due out later this year by signing up for my newsletter. Newsletter subscribers will also be notified about live training opportunities and free or discounted books. Sign up here – 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 the about the author page. For information about my other writing work beyond this blog check out my Google+ page or the Facebook author’s page, up under David Joel Miller. Posts to the “books, trainings, and classes” category will tell you about those activities. If you are in the Fresno California area, information about my private practice is at counselorfresno.com. A list of books I have read and can recommend is over at Recommended Books

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

By David Joel Miller.

Standard drinks and why they matter.

Alcohol

Alcohol.
Photo courtesy of Pixabay.com

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

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 or 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 blood stream. 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 blood stream.

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 blood stream.

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 black out, organs stop working and you get pronounced legally dead.

Also, you need to know that if every time you drink, you end up drunk, that 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 a 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 blood stream.

Want to sign up for my mailing list?

Get the latest updates on my books, due out later this year by signing up for my newsletter. Newsletter subscribers will also be notified about live training opportunities and free or discounted books. Sign up here – 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 the about the author page. For information about my other writing work beyond this blog check out my Google+ page or the Facebook author’s page, up under David Joel Miller. Posts to the “books, trainings and classes” category will tell you about those activities. If you are in the Fresno California area, information about my private practice is at counselorfresno.com. A list of books I have read and can recommend is over at Recommended Books