Tag Archives: What is

What are Somatic Symptom and Related Disorders?

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

What is

What are Somatic Symptom and Related Disorders?
Photo courtesy of Pixabay.

Your mind and your body are connected.

The Somatic Symptom and Related Disorders chapter in the DSM 5 covers a group of disorders in which both the body and the emotions play a role. A lot of people think of the mind and the body as two separate things. They would like to believe that if you are sick, that means there was something wrong in your body. Otherwise – your pain is all in your head. The truth is emotional problems can make you physically ill, and illnesses that originated the body can significantly impact your emotional health.

People with Somatic Symptom and Related Disorder are primarily seen in medical settings, often by primary care physicians. They are less often seen in mental health settings, and then primarily because their doctor referred them. Some of these conditions are quite rare in the general population. If a condition affects one in 300 people, then there would be over 1,000,000 people in the U.S. with that condition.

Many emotional and mental disorders create physical symptoms in the body. Depression characteristically causes changes in sleep and appetite as well as a loss of energy and motivation. Anxiety disorders can cause dizziness, sweating, light-headedness, shortness of breath, and many other physical symptoms. Panic Disorder manifests with symptoms similar to a heart attack or respiratory failure.

This group of disorders displays significant physical or somatic symptoms. The pain and suffering of the body are readily apparent. In these conditions, there is also significant distress and impairment in your ability to work, create, and maintain relationships, or enjoy other important areas of your life. People with Somatic Symptoms Disorders are very upset by their symptoms.

This family of diagnoses should not be used simply because the doctor has been unable to find a medical explanation for the condition. Somatic Symptoms Disorders also require a change in the way the patient sees their symptoms. What the doctor or therapist is looking for is the way in which the patient’s thoughts, feelings, and behaviors, are being altered because of the physical symptoms. Somatic Symptom Disorder, the most common among this family of disorders, is often present in combination with another diagnosed physical illness. When both conditions are present, it becomes more difficult to treat and may require the services of both a medical doctor and a therapist.

Risk factors for developing a Somatic Symptom Disorder.

Having a history of traumatic experiences in early life increases the risk of a Somatic Symptom Disorder. Stress is more than just a feeling. When under stress, hormones, and neurotransmitters change. Living with high levels of stress hormones alters the functioning of the nervous system. Other risk factors include increased sensitivity to pain, chronic pain, or living in an environment where no one listens to your needs unless you report physical pain.

Other disorders related to somatic symptoms.

Here is a short list of other disorders related to Somatic Symptom Disorder.

Illness Anxiety Disorder.

Conversion Disorder.

Facetious Disorder.

False Pregnancy (Pseudocyests)

Brief forms of Somatic Symptom Disorders.

As with the other things we are calling a mental illness, these conditions need to interfere with your ability to work or go to school, your relationships, your enjoyable activities or cause you personal distress. Otherwise, you may have the issues, but you will not get the diagnoses if this is not causing you a problem. If the only time this happens is when under the influence of drugs or medicines, or because of some other physical or medical problem, this problem needs to be more severe than your situation would warrant. These other issues need treating first; then if you still have symptoms, you could get this diagnosis.

FYI These “What is” sometimes “What are” posts are my efforts to explain terms commonly used in Mental Health, Clinical Counseling, Substance Use Disorder Counseling, Psychology, Life Coaching, and related disciplines in a plain language way. Many are based on the new DSM-5; some of the older posts were based on the DSM-IV-TR, both published by the APA. For the more technical versions, please consult the DSM or other appropriate references.

See Recommended Books.     More “What is” posts will be found at “What is.”

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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What is an Adjustment Like Disorder? (F43.9)

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

What is

What is an Adjustment Like Disorder? (F43.9)
Photo courtesy of Pixabay.

When is an adjustment disorder not an adjustment disorder?

Sometimes people have symptoms as a result of experiencing trauma or stress.

These difficulties are sufficiently severe that we think this person needs treatment but the exact group of symptoms they have doesn’t quite fit a listed disorder.

The new DSM – 5 solves this problem by creating another name for adjustment like disorders.

Other Specified Trauma- and Stressor-Related Disorders (F43.9)

This designation gives us five more ways to categorize problems of everyday living which were caused by stressors or trauma but do not quite neatly fit the defined adjustment disorders.  Below are the five reasons you might get an adjustment like disorder diagnosis.

1. You had a stressor but your problems did not begin until more than three months after the stressor.

2. The problems continue for more than six months even though the stressor has ended but your symptoms have not turned into another diagnosis.

3. You were having an “ataque de nervious.” This particular condition is listed in the back of the DSM – 5 under cultural concepts of distress. While not recognized in the United States as a mental disorder, this particular group of symptoms is widely recognized in Spanish-speaking countries.

4. Another cultural syndrome. There are a number of cultural syndromes that are recognized in a particular geographic or ethnic area.  The cultural syndromes are understood as an inability to cope with a particular stressor.

5. Persistent Complex Bereavement Disorder. This condition is listed in an appendix to the DSM under conditions for further study.  Since it didn’t make the list of official diagnoses, researchers needed a way to code it.  The result is this condition ended up here under adjustment like disorders.

I don’t think I’ve ever seen an adjustment like disorder listed in the person’s chart nor have I ever use this particular diagnosis myself.  But when I saw it was right there in the DSM-5 I just couldn’t resist letting you all know about this.  Maybe this illustrates how learning to diagnose mental illnesses is both an imprecise science and an area for continuing learning.

As with the other things we are calling a mental illness this adjustment like disorder needs to interfere with your ability to work or go to school, your relationships, your enjoyable activities or cause you personal distress. Otherwise, you may have the issues but you will not get the diagnoses if this is not causing you a problem. If the only time this happens is when you are under the influence of drugs or medicines or because of some other physical or medical problem this issue needs to be more severe than your situation would warrant. These other issues may need treating first, then if you still have symptoms you could get this diagnosis.

FYI These “What is” sometimes “What are” posts are my efforts to explain terms commonly used in Mental Health, Clinical Counseling, Substance Use Disorder Counseling, Psychology, Life Coaching, and related disciplines in a plain language way. Many are based on the new DSM-5; some of the older posts were based on the DSM-IV-TR, both published by the APA. For the more technical versions please consult the DSM or other appropriate references.

See Recommended Books.     More “What is” posts will be found at “What is.”

For more on this topic see Adjustment Disorders in the Trauma- and Stressor-Related Disorders category.

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 are the six types of Adjustment Disorders?

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

What is

What are the six types of Adjustment Disorders?
Photo courtesy of Pixabay.

Adjustment Disorders include six types or specifiers.

In another post, I wrote about adjustment disorders. You might want to take a look at that post.  You will find it in the trauma- and stressor-related disorders category. But to briefly recap, an adjustment disorder is a time when you experience stress and that amount of stress is more than you can handle.

The kind of things that you might find stressful, and how that stress might affect you, can vary a great deal from one person to another.  Adjustment Disorder can be very chameleon-like, changing from person to person and from time to time. As a result of this variation and in order to help find the correct treatment for each person, professionals use six different specifiers for various presentations of adjustment disorder.  Listed below are the six specifiers or sub-types of adjustment disorder that are listed in the new DSM – 5.

Adjustment Disorder with Depressed Mood (F43.21).

Sometimes in addition to having difficulty coping with a stressor, as a result of this life problem, people develop depression.  If this goes on long enough or is severe enough they might eventually get a diagnosis of Major Depressive Disorder.  But until that happens treatment will mainly focus on the stressor and the depression that stressor is causing.

Adjustment Disorder with Anxiety (F43.22).

Sometimes the primary symptom that people experience when they are going through stress is an increase in their anxiety.  If this increase in anxiety is related to a specific stressor, is more severe than we expect, or goes on too long, Adjustment Disorder with Anxiety is the likely problem.

Adjustment Disorder with both Depression and Anxiety (F43.23).

Anxiety and depression frequently happen to people at the same time.  If this stressor has produced both depression and anxiety, then this specifier should be added.

Adjustment Disorder with Conduct Problems (F43.24).

Sometimes the principle way we know that stress has affected somebody is that they begin to act in inappropriate ways.  This diagnosis with this specifier is most commonly seen in children who rather than show their symptoms as anxiety or depression, begin to act out.

Adjustment Disorder with Disturbance of Emotions and Conduct (F43.25).

When stress overcomes a person’s ability to cope, we may see changes both in their behavior and in their feelings.  This is often the case in children and adolescents but may also be seen in adults with poor emotional regulation.

Adjustment Disorder Unspecified (F43.20).

When the counselor knows that the problem the client has is caused by their reaction to stress but none of the other sub-types quite seem to fit, this category may be used.

As with the other things we are calling a mental illness this problem needs to interfere with your ability to work or go to school, your relationships, your enjoyable activities, or cause you personal distress. Otherwise, you may have the issues but you will not get the diagnoses if this is not causing you a problem. If the only time this happens is when you are under the influence of drugs or medicines or because of some other physical or medical problem, this problem needs to be more than your situation would warrant. These other issue needs treating first, then if you still have symptoms you could get this diagnosis.

FYI These “What is” sometimes “What are” posts are my efforts to explain terms commonly used in Mental Health, Clinical Counseling, Substance Use Disorder Counseling, Psychology, Life Coaching, and related disciplines in a plain language way. Many are based on the new DSM-5; some of the older posts were based on the DSM-IV-TR, both published by the APA. For the more technical versions please consult the DSM or other appropriate references.

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 Selective Mutism (F94.0)?

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

Selective Mutism is the failure to speak at times when speech is necessary.

What is

What is Selective Mutism (F94.0)?
Photo courtesy of Pixabay.

Selective Mutism is an interesting disorder. It is one of the less common anxiety disorders and one which commonly first appears in childhood.  This disorder often co-occurs with Social Anxiety Disorder.  As with all the anxiety disorders, Selective Mutism may continue well into adulthood.

Selective Mutism is not the inability to speak or the willful refusal to speak.  Selective Mutism occurs when someone chooses not to speak in a particular situation even when not speaking may cause them difficult.  Children with this condition will avoid starting a conversation with other children.  When spoken to they will fail to respond.

Selective Mutism gets noticed when children begin to attend school.

Children with Selective Mutism do poorly in school because they do not respond verbally to the teacher and do not read out loud.  Those with this disorder may use other ways of communicating rather than speaking.  Sometimes they will point, grunt, or used personally significant gestures.  They may also be willing to engage in social activities when speech is not required.

Children with Selective Mutism are able to speak normally at home with their parents or primary caregivers.  They may be unwilling to speak in the presence of close relatives including cousins, aunts and uncles, and grandparents.

Risk factors for Selective Mutism.

Children who are shy are at extra risk to develop this disorder.  Having parents who are withdrawn or growing up in a socially isolated environment may also be risk factors.  It is possible that having overprotective or controlling parents increases this risk.  There’s some evidence that children with this disorder have difficulty understanding the things that are said to them.  Having Social Anxiety Disorder or a family history of it may also increase the risks.

Other problems may accompany Selective Mutism.

People with Selective Mutism also frequently are shy and experience social embarrassment.  They may be isolated and withdrawn.  Children with Selective Mutism may be clingy and become easily upset.  They may also exhibit temper tantrums and oppositional behavior.

Having this disorder early in life and not getting treatment for it puts the child at extra risk for poor development and failure to learn needed social skills.

Things that are excluded from a Selective Mutism diagnosis.

To get this diagnosis, this condition of not speaking even when you need to speak must go on for a month or more.  If the thing keeping you from speaking is the result of not knowing the English language or being bilingual in some way, this is not a case of Selective Mutism.

Also excluded from the definition of Selective Mutism are things related to speech fluency.  If the person involved is experiencing an episode of hearing voices, if being psychotic, or a schizophrenia-like condition, this also is outside the definition of Selective Mutism.

FYI These “What is” sometimes “What are” posts are my efforts to explain terms commonly used in Mental Health, Clinical Counseling, Substance Use Disorder Counseling, Psychology, Life Coaching, and related disciplines in a plain language way. Many are based on the new DSM-5, some of the older posts were based on the DSM-IV-TR, both published by the APA. For the more technical versions please consult the DSM or other appropriate references.

More “What is” posts will be found at What is.

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 Reactive Attachment Disorder (RAD) F94.1?

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

What is

What is Reactive Attachment Disorder (RAD) F94.1?
Photo courtesy of Pixabay.

Reactive Attachment Disorder begins early in life.

Reactive Attachment Disorder (RAD) is one of those disorders which was moved in the DSM-5.

It used to be included in the chapter on Disorders First Diagnosed in Infancy, Childhood, and Adolescence.

RAD now appears in the chapter on Trauma- and Stressor-Related Disorders.

Reactive Attachment Disorder is the result of deficiencies in early life care.

Reactive Attachment Disorder is an internalizing disorder. A related disorder called Disinhibited Social Engagement Disorder involves externalizing behaviors.  Both conditions are thought to be caused by poor caregiving early in life. RAD involves a consistent pattern of shutting down, withdrawing, and inhibiting emotions. This disorder starts before age five and is rarely given after that age.

While this is a diagnosis primarily applied to very young children, in working with adults we often see conditions that probably began as Reactive Attachment Disorder.  A common statement is that they “just don’t get close to others.” This condition involves an inability to regulate emotion and unexplained anger, both issues we frequently see in adults who came from dysfunctional homes.

With children, we usually know that the symptoms are caused by neglect and poor parenting.  With adults, similar symptoms show up as depression, chronic sadness, anxiety disorders, or even personality disorders.  Our understanding of reactive attachment disorder is pretty much an all or nothing condition.  I can’t help wonder about the effects which varying degrees of neglect or failure to meet the child’s emotional needs might be causing.

Reactive Attachment Disorder involves a consistent behavioral pattern.

Most of the Trauma- and Stressor-Related Disorders are related to anxiety and obsessive-compulsive disorders and are fear-based. Reactive Attachment Disorder is about shutting down and internalizing. In Reactive Attachment Disorder, there is chronic sadness, depression, and loss of pleasure.  There may also be accompanying anger, aggression, and dissociation. This involves a lot of withdrawal and inhibited emotion.

Reactive Attachment Disorder involves social and emotional problems.

Children with RAD are unresponsive to others.  They’re rarely happy or positive.  RAD involves frequent irritation, sadness and sometimes being afraid. Children with this disorder often react to adult caregivers in a negative way for no apparent reason. These patterns of poor relationships with adults continue even when caregivers change.

In adults, we see similar patterns with those people who get diagnosed with Persistent Depressive Disorder.  They often say they do not ever remember being happy.  What we often don’t know is if this person really had deficient care as a child or if they had a temperament which makes them difficult to parent.  Sick, or irritable temperamental children are harder to parent and more likely to be abused or neglected.

Extremely deficient care results in Reactive Attachment Disorder.

Characteristics of this less-than-adequate care include emotional needs not being met, frequent changes in caregivers, and being raised in impersonal institutionalize settings.  Mostly this deficient care results in poor relationships with caregivers and other adults, but it may also affect peer relationships.

Sometimes other things look like Reactive Attachment Disorder.

Sometimes children with Autism or developmental delays exhibit symptoms that can look like Reactive Attachment Disorder. In young children, it is important to be sure the problems were caused by poor caregiving.  In adults, we see behaviors that we suspect began as Reactive Attachment Disorder, but without a prior diagnosis, we can’t be sure. RAD may affect many other developmental areas.

Some cautions.

As with the other things we are calling a mental illness this RAD needs to interfere with the ability to work, or in children, go to school, relationships, or other enjoyable activities or cause personal distress. Otherwise, there may be issues, but the diagnoses will not be given. If the only time this happens is when someone is under the influence of drugs or medicines or because of some other physical or medical problem these problems would need to be more than the situation otherwise warrants. These other issues may need treating first, then if there are still symptoms, the diagnosis will be given.

Treatment for Reactive Attachment Disorder.

For children, getting into a situation with a caring, responsible, caregiver, can make all the difference.  For adults with problems now, which may or may not be the result of early childhood experiences, there are several therapies which may be helpful.

It is imperative that children who have Reactive Attachment Disorder get treatment early to prevent lifelong difficulties.  Adults who struggle with emotional difficulties may find that they still have early childhood issues that need to be addressed before their adult problems will resolve.

FYI These “What is” sometimes “What are” posts are my efforts to explain terms commonly used in Mental Health, Clinical Counseling, Substance Use Disorder Counseling, Psychology, Life Coaching, and related disciplines in a plain language way. Many are based on the new DSM-5; some of the older posts were based on the DSM-IV-TR, both published by the APA. For the more technical versions please consult the DSM or other appropriate references.

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 Amotivational Syndrome?

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

Unmotivated.
Photo courtesy of Pixabay.com

Have you lost your drive or your desire to do something?

Amotivational Syndrome is often connected with the smoking of marijuana.  This is something quite different from what we see in depression.  In depression, people lose the desire to do things they use to make them happy.  We call that loss of pleasure anhedonia.

In Amotivational Syndrome people seem to spend more time looking inward and contemplating things and less time actively doing them.  This syndrome was originally recognized in younger, marijuana smokers who were heavier daily users.

Does marijuana smoking cause a loss of motivation?

Things that are, or were, associated with Amotivational Syndrome include the development of apathy and loss of ambition.  Heavy smokers just seem to become indifferent and stop caring about anything except smoking.  They seem to have fewer goals and decreased effectiveness.  Problems with attention and concentration have also been attributed to heavy marijuana smoking and Amotivational Syndrome.

Many of these characteristics are seen in daily, heavy, marijuana smokers.  What is unclear is whether marijuana smoking causes this cluster of symptoms or whether those people who are low in motivation like to smoke marijuana.  At one point it was commonly accepted that some marijuana smokers are likely to suffer from Amotivational Syndrome.

Not all marijuana smokers are low in motivation.

Because of the many famous, popular people, who have been reported to be regular marijuana smokers, the connection between smoking marijuana and low motivation has come into question. It is unclear how common this condition is, or even if this is a valid syndrome.  Amotivational Syndrome has not been reported in countries other than the United States.  There’s some question whether Amotivational Syndrome is, in fact, a cultural rather than a mental condition.

Animals on marijuana don’t lose motivation.

Laboratory studies of both humans and animals have not found evidence of the Amotivational Syndrome for those using marijuana.  Amotivational Syndrome or loss of goals and direction has been found in many groups of young people who are not using marijuana on a regular basis.  This has led some writers to conclude that Amotivational Syndrome is a personality characteristic rather than the result of smoking marijuana.  It may be that those people with low motivation are attracted to using marijuana and other intoxicating substances.

One other possibility that has been suggested is that those people who are under the influence of drugs and alcohol or other substances may have low motivations to do anything while under the influence.  What we may be seeing in those people who were described as having Amotivational Syndrome may, in fact, be the effects of intoxication and withdrawal from marijuana or other substances.

As with the other things we are calling a mental illness or symptoms of a mental illness Amotivational Syndrome would need to interfere with your ability to work or go to school, your relationships, your enjoyable activities, or cause you personal distress for it to be the focus of clinical attention. Otherwise, while you may have lost some motivation you will not be identified as someone needing clinical assistance.  If the only time you have low motivation is when you are under the influence of marijuana or another drug this would be diagnosed as drug intoxication.

For more on this and related topics see the other posts on counselorssoapbox.com under        Drug Use, Abuse, and Addiction

FYI These “What is” sometimes “What are” posts are my efforts to explain terms commonly used in Mental Health, Clinical Counseling, Substance Use Disorder Counseling, Psychology, Life Coaching, and related disciplines in a plain language way. Many are based on the new DSM-5; some of the older posts were based on the DSM-IV-TR, both published by the APA. For the more technical versions please consult the DSM or other appropriate references.

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 are personality disorder clusters?

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

What is

What are personality disorder clusters?
Photo courtesy of Pixabay.

What are the three main groups of personality disorders?

The newest edition of the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders divides personality disorders into three categories based on their similarities.  Personality disorders are long-term or enduring patterns of behavior.  The old way of thinking about these issues was that this is just the way someone is and treatment was not likely to be successful.

Recently treatments for many of the personality disorders have become available.  Currently, we think of many of these personality disorders as problems of living which may occur in varying degrees.  Someone who is low in self-esteem might be described as low in narcissism.  If they were high in narcissism they might be lacking in the ability to empathize with others.  Below is a list of the clusters of Personality disorders with brief descriptions of the disorders in that cluster.  For longer discussions of the personality disorders see separate posts on the specific personality disorder.

Cluster A personality disorders.

This group of personality disorders includes people who appear odd or eccentric.  Among the Cluster, A personality disorders, are Paranoid Personality Disorder, Schizoid Personality Disorder, Schizotypal Personality Disorder.

Paranoid Personality Disorder involves people who are more fearful of people, life, and events that would be warranted.  They are especially likely to think that other people are out to get them.

Those with Schizoid Personality Disorder are detached from others and seem to have little desire to have close personal relationships. They have less ability to express emotions.

In Schizotypal Personality Disorder, people are very uncomfortable in close relationships, have eccentric behavior, and may have thinking or perceptual difficulties.

Cluster B personality disorders.

Cluster B personality disorders include things like Antisocial Personality Disorder, Borderline Personality Disorder, Histrionic Personality Disorder, and Narcissistic Personality Disorder.

Those with antisocial personality disorder seem to have little regard for others and their rights.  They don’t mind taking advantage of people around them.  This is different from those people who may make a living out of crime and intentionally steal from, or harm others.  Career criminals get a diagnosis of Adult antisocial behavior Z72.811.

People with Borderline Personality Disorder are likely to have a poor self-image, low self-esteem, fluctuating emotions, and often are very impulsive in their relationships.  Those with Borderline Personality Disorder may also self-harm.

Histrionic Personality Disorder might be described as the typical “Sarah Bernhardt” actress.  Someone with histrionic personality disorder is excessively emotional and is always looking for more attention.

Cluster C personality disorders.

Cluster C personality disorders include disorders related to relationships with other people.  These personality disorders in Cluster C are thought to begin in early childhood. They include unusual ways of relating to close people in their life. This includes Avoidant Personality Disorder, Dependent Personality Disorder, and Obsessive-Compulsive Personality Disorder.

People with Avoidant Personality Disorder avoid other people, feel that they’re inadequate, and are often very sensitive to criticism.

Those with Dependent Personality Disorder are the people likely to become co-dependents.   They are often submissive, clingy, with an excessive need to find someone who will take care of them and control their lives.

Obsessive-Compulsive Personality Disorder is different and separate from Obsessive-Compulsive Disorder.  When the pattern of being obsessive-compulsive becomes a preoccupation with orderliness, perfection, control, having everything exactly the way they need it to be at all times, this moves from a single obsessive-compulsive behavior to the level of a continuing personality disorder.

In addition to the three personality disorder clusters, two other personality disorder characteristics are described in the DSM-5.  Sometimes a personality disorder can be the result of medical conditions.  The DSM-5 also allows for other specified personality disorder or other unspecified personality disorder when one exists that does not fit this list.

Each of these personality disorders is described more completely in other “What is” posts about that specific personality disorder.

As with the other things we are calling a mental illness this needs to interfere with your ability to work or go to school, your relationships your enjoyable activities, or cause you personal distress.

Having mild forms of these disorders does not qualify unless it causes you problems.  In that case, you may have the issues, but you will not get the diagnoses. If the only time this happens is when under the influence of drugs or medicines or because of some other physical or medical problem these characteristics need to be more than your situation would warrant. These other issue needs treating first, then if you still have symptoms you could get this diagnosis.

FYI These “What is” sometimes “What are” posts are my efforts to explain terms commonly used in Mental Health, Clinical Counseling, Substance Use Disorder Counseling, Psychology, Life Coaching, and related disciplines in a plain language way. Many are based on the new DSM-5; some of the older posts were based on the DSM-IV-TR, both published by the APA. For the more technical versions please consult the DSM or other appropriate references.

See also Recommended Books.    “What is.” and Personality Disorders

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 a Standard Drink?

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

The taste may change but the alcohol stays the same.

What is a Standard Drink?
Photo courtesy of Pixabay.com

Only one kind of alcohol, ethanol, is drinkable. Ethanol or ethyl alcohol is made from fermenting a liquid made from fruit, grains, or similar vegetative products. Sometimes this chemical is called grain alcohol. While chemically similar, all the types of alcohol other than Ethanol can do significant harm, including cause blindness or death, when consumed. From here on, when I say alcohol, I am talking exclusively about the ethanol type.

The folk-lore of drinking contains lots of myths about what to drink and how to drink it. People may think that if they only drink beer or wine then they can’t become alcoholics. Some people give up “the hard stuff” thinking this will prevent them from having a problem with alcohol. Most of this belief that one alcoholic drink is better or worse than another is based on misconceptions about the content of alcoholic drinks.

No matter what we call an alcoholic beverage, what it is made from or what flavorings and additives are included, the pure alcohol part of alcoholic beverages is the same. All drinkable alcoholic beverages contain ethanol. Ethanol is the component that gets you drunk and withdrawal from ethanol, no matter the source, is what causes a hangover.

In order to compare the amount of pure alcohol contained in various beverages we use a concept called a “standard drink.” That standard drink is the amount of a beverage that contains one-half an ounce of pure ethanol.

In some places, the alcohol content is calculated by weight and in other places, it is calculated by volume. Depending on whether the alcohol is measured by weight or by volume and depending on who does the measuring we can get slightly different numbers here. Either way, the results of alcohol are pretty much the same.

Beer has the smallest percentage of alcohol.

Beers can vary between three and seven percent alcohol. Most of the major commercial beers in the U. S. are at the low end, close to 3 % and a twelve-ounce beer is considered a standard drink. Many people believe that because beer has a lower alcohol content it is safer and less likely to lead to problems. Unfortunately, that turns out to not be true. Because beer has a lower alcohol content per standard drink most people just drink more volume of beer than they would if drinking another alcoholic beverage. More than half the pure alcohol consumed every year here in the U. S. comes from beer.

Wine is a little stronger and can vary more.

Typical wines come in at eight to fourteen percent alcohol. The various textbooks I consulted gave between four and five oz. of wine as a standard drink. Wine can be fortified by adding alcohol distilled from some other alcoholic beverage. By fortifying a wine it can be pushed up to as much as twenty-two percent ethyl alcohol.

Spirits or Hard Liquor are the result of distillation.

As the fermentation progresses the alcohol begins to prevent the yeast from working so the process of fermentation stops. To get stronger alcoholic beverages some manipulation is required. If the liquid is heated, the alcohol evaporates faster than the water and other components. Catch this steam which is largely alcohol, condense it, and you get a beverage with a higher concentration of alcohol. We call this product with the concentrated levels of alcohol, spirits, or hard liquor.

A standard drink containing spirits is about one “shot” of an 86 proof liquor. Proof numbers are twice the percentage numbers so this shot contains about half an ounce of pure alcohol.

Glass size and proof matter.

In trying to compare the amount of alcohol in one drink with another it is important to keep in mind that a glass of wine is defined as a 4 to 5 ounce glass size.  Pouring the wine into a 32-ounce tumbler does not mean a tumbler full is still one standard drink.

When the “proof” changes so should the size of the drink. Stronger spirits should be served in smaller glasses. In practice, people still pour more than one standard drink into their glass resulting in some drinks that contain way more than “one standard drink.” Even beer can become deceptively intoxicating if served in a mug that holds more than 12 ounces.

The problem with counting standard drinks.

The whole idea of standard drinks was to predict the effects of drinking a glass of a particular alcoholic beverage. In practice, most people are taking in more alcohol than they realize and the heavy or binge drinkers are drinking way more drinks than they planned.

If you are having a problem with controlling your drinking the answer is not in measuring standard drinks. If when you drink you consume more than intended or bad things happen to you, there is a good chance that you have an Alcohol Use Disorder. Stop trying to find a way to beat the game and drink more but not get drunk and get some help from a support group like A. A. or a professional counselor.

For more on this topic see:  Alcoholism       Drug Use, Abuse, and Addiction

Terms and their meaning can differ with the profession using them. The literature from the Rehab or AOD (Alcohol and Other Drug) field may be very different from that in the mental health field. There is still a large gap between recovery programs and AOD professionals and the terms and descriptions used in the DSM.

FYI These “What is” sometimes “What are” posts are my efforts to explain terms commonly used in Mental Health, Clinical Counseling, Substance Use Disorder Counseling, Psychology, Life Coaching, and related disciplines in a plain language way. Many are based on the new DSM-5; some of the older posts were based on the DSM-IV-TR, both published by the APA. For the more technical versions please consult the DSM or other appropriate references.

See Recommended Books.     More “What is” posts will be found at “What is.”

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

Persistent Depressive Disorder – PDD (F34.1)

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

What is

What is Persistent Depressive Disorder?
Photo courtesy of pixabay.

What if you don’t ever remember being happy?

Persistent Depressive Disorder – PDD (F34.1) is new to the DSM-5. The DSM is the book professionals use to identify mental illnesses. This diagnosis is the result of merging Dysthymia and another group of symptoms which was being researched as Chronic Major Depression. Some other variations on the depressive theme were being called Minor Depressive Disorder, which did not get recognized as such but kind of fits here.

While we may label these conditions as chronic or minor, there is nothing minor about them if you are someone who has this condition?

The defining characteristic of Persistent Depressive Disorder – PDD, is a pervasive sadness that just won’t go away. People who have this condition are always sad or unhappy. They may describe themselves as “always down” or having the blues. While this can cause a lot of impairment, people who have PDD come to think of their chronic sadness as “Just the way I am.”

It is estimated that about two percent of the U. S. population has PDD. Many people with PDD also experience a substance use disorder. There is also an overlap between PDD and Cluster B and Cluster C personality disorders, both of which, to my way of thinking, may have their roots in negative childhood experiences.

Persistent Depressive Disorder (PDD) is more disabling than Major Depressive Disorder.

PDD has been identified on brain scans and seems to affect at least four separate brain regions. PDD is long-lasting, at least two years, often more. During this time someone with PDD may also experience an episode of Major Depressive Disorder. While the major depressive episode may come and go the PDD often remains relatively constant. Because of this constant feature, people with PDD may not be able to ever feel really happy and their functioning, day-to-day, is more impacted than those with Major Depressive Disorder only.

Persistent Depressive Disorder (PDD) is chameleon-like.

Chronic unending depression has a lot of variations. This disorder can exhibit itself a great many ways. As a result, there are eighteen separate specifiers that can and should be added after the F43.1 These specifiers are not exclusive, so one person may also get several specifiers added to the Persistent Depressive Disorder (PDD) diagnosis.

Specifiers include with:

Anxious distress – anxiety commonly co-occurs with depression.

Mixed features

Melancholy features

Atypical features

Mood-congruent psychotic features

Mood-incongruent psychotic features

Peripartum features

In partial remission

In full remission

Early onset – before 21

Late onset – at or after age 21

Pure dysthymia syndrome

Persistent major depressive episode

Intermittent major depressive episode, currently with MDD

Intermittent major depressive episode, currently without MDD

Mild

Moderate

Severe

The symptoms of Persistent Depressive Disorder.

To qualify for PDD a person should have the following symptoms:

  1. Felt depressed or down, or had others see them this way, most of the day, most days, over a two-year period.
  2. Had at least two of the following six symptoms. These symptoms should be caused by emotions not by dieting or working long hours, etc.
  3. Change in appetite either up or down.
  4. Changes in sleep either too much or too little.
  5. Felt low in energy or fatigued a lot.
  6. Low self-esteem.
  7. Difficulty deciding things or poor concentration.
  8. Hopeless.
  9. Most of the usual exclusions. This has to be causing problems with work, school, relationships, should interfere with important activities or upset the client. It should not overlap Bipolar Disorder or Psychotic Disorder but may overlap Major Depressive Disorder. These symptoms should not be the result of medical or substance use issues.
  10. These symptoms have been constant and not gone away for two months or more over the required two-year period.

Be careful with the PDD label.

Calling Persistent Depressive Disorder by the label PDD could be problematic. In the past, we had another PDD – Pervasive Developmental Delay which is now recognized as a part of the Autism Spectrum. Persistent Depressive Disorder – PDD is about depression and has nothing to do with Autism. Be careful in reading articles that if they use the label PDD you know which of these two they are talking about. From here on I will call Persistent Depressive Disorder – PDD.

As with the other things we are calling a mental illness this needs to interfere with your ability to work or go to school, your relationships, your enjoyable activities, or cause you personal distress. Otherwise, you may have the issues but you will not get the diagnoses if this is a personal characteristic, not a problem. If the only time this happens is when you are under the influence of drugs or medicines or because of some other physical or medical problem these symptoms need to be more than your situation would warrant. These other issues may need treating first, then if you still have symptoms you could get this diagnosis.

FYI These “What is” sometimes “What are” posts are my efforts to explain terms commonly used in Mental Health, Clinical Counseling, Substance Use Disorder Counseling, Psychology, Life Coaching, and related disciplines in a plain language way. Many are based on the new DSM-5; some of the older posts were based on the DSM-IV-TR, both published by the APA. For the more technical versions please consult the DSM or other appropriate references.

More “What is” posts will be found at “What is.”  and Depression  

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 Polydrug or Polysubstance use?

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

Polydrug use is common.

Drugs

What is Polydrug or Polysubstance use?
Photo courtesy of Pixabay.com

Polydrug use, sometimes referred to as multiple drug use, is an increasingly common pattern. Diagnosis of Substance Use Disorders used to be divided along the lines of the particular substance that someone used or abused. Treatment systems separated the alcoholics from the Heroin users and so on. There was a lot of validity to that model but it is becoming less and less possible as more people are using combinations of many drugs.

Most drug users have a preferred “High.” Stimulant users like being way up. Depressant users like the falling asleep, passing out kind of high. Hallucinogen users are chasing an altered reality. Some people dabble in all three types and their pattern of addiction is more to the process of using drugs than to any one particular substance.

I have heard people with a history of polysubstance use describe themselves as “trashcan junkies” just open the lid and throw something in. When asked what drugs they do, the standard answer is “What have you got?”

Drugs of abuse have cultures.

Alcohol users and abusers tend to hang out together. They have their preferred beverage of choice and their favorite method of consumption. If you drink the way others in your social circle drink then you can maintain the illusion that your drinking is under control. Some drinking groups divide up a 12 or 24 pack, some pass around a bottle of wine or a paper bag containing the hard stuff. Other groups order fancy mixed drinks from the cocktail waitress. Alcohol is everywhere and most people develop some familiarity with this culture.

Weed smokers have their culture also. They pass around the blunt, smoke a bowl or roll a joint. They have particular names for the varieties of marijuana they smoke or those they disdain. Most drink alcohol from time to time. Many weed smokers also have cultural decorations, tribal music, and cultural heroes who smoked a lot of weed. But in a group of consistent marijuana users, it is likely that most primarily smoke marijuana.

Heroin users develop their own special culture. They know the process of making a rig. Users learn the concepts of going to the cotton and cotton fever. They also know the struggles of kicking and going cold turkey.

Some of the younger opiate abusers believe they are from a different tribe. They do their opiates as pills and liquids, obtained from doctors, pharmacies, and diverted medical supplies. They may even hold fast to the myth that they are not addicts because they do not use needles. That myth gets shattered when their supply is interrupted and they have to kick along with the heroin addicts.

Polysubstance users move between cultures.

Increasingly we are seeing those whose allegiance is not to one drug of choice but to the process of doing drugs of any and every kind. The use of multiple substances is the norm rather than the exception. Most people in drug treatment and a major part of our jail and prison populations have long histories of using a wide variety of substances.

Polysubstance dependence is a problem without a diagnosis.

The most recent edition of the DSM eliminated the diagnosis of polysubstance dependence. We never did use polysubstance abuse. From here on the plan is to list each drug someone may have developed a problem with and then rate each use disorder as mild, moderate or severe.

For those working in the Substance Use Disorder field, this is problematic. While a client may have a mild problem with each of eight or ten different drugs, overall they can have a significant problem living life without using drugs or destructive behaviors.

My own experience has been that when someone has this “polysubstance dependence” problem, there are usually some other significant mental health issues going on.  The best treatment when polysubstance abuse or dependence is encountered is the treatment of the mental health issues and substance use issues at the same time.

Terms and their meaning can differ with the profession using them. The literature from the Rehab or AOD (Alcohol and Other Drug) field may be very different from that in the mental health field. There is still a large gap between recovery programs and AOD professionals and the terms and descriptions used in the DSM.

FYI. These “What is” sometimes “What are” posts are my efforts to explain terms commonly used in Mental Health, Clinical Counseling, Substance Use Disorder Counseling, Psychology, Life Coaching, and related disciplines in a plain language way. Many are based on the new DSM-5; some of the older posts were based on the DSM-IV-TR, both published by the APA. For the more technical versions please consult the DSM or other appropriate references.

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