What is the ACA?

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

What is

What is an adult child of an alcoholic?
Photo courtesy of Pixabay.

How many ACA’s are there?

These initial things don’t always mean what we think. Different groups of people mean different things by the same set of initials and the same group or condition may get more than one shortened reference. Currently, we are struggling with a sudden shift in the meaning of ACA. I will give you some possible meanings for ACA in a moment.

Context matters.

There is a lot of research out there and more being published every day. Sometimes I think that I read way too much of that research. Is there a treatment for excessive research preoccupation?

The convention in research is that the first time a writer uses a term in their article they give the full name of the condition, theory, or test instrument they used followed by the abbreviation they will be using in parentheses. Thereafter they use only the abbreviation.

For example, older articles on Pervasive Developmental Delay used to read Pervasive Developmental Delay (PDD.) Thereafter the article would only talk about PDD. With the DSM-5, Pervasive Developmental Delay became a part of the Autism Spectrum Disorder (ASD.) There is now a new disorder Persistent Depressive Disorder (PDD.) Persistent Depressive Disorder is pretty much like the thing we used to call Dysthymia.

So if you see PDD in an article look back to the beginning of the article and see what the original term was that is being shortened to PDD.

So what is ACA?

In the mental health field, ACA has several meanings. Most likely these days ACA refers to the Affordable Care Act (ACA.) This is big here in America, right now, in that it expanded medical coverage to a lot more people. Unfortunately, this does not mean that everyone here in the U. S. has medical insurance. There are still a lot of poor people who do not have medical insurance. We still have a long way to go to get everyone health insurance.

This does not mean those uninsured people do not receive medical care. They still show up in hospital emergency rooms and get free care there. The difference is that without insurance there is no provision for who will pay for that care and so the public gets the bill. Sure if you have no insurance they mail you a bill, but if you are homeless you are not likely to pay that bill.

The result of this system is that the uninsured are discouraged from seeking care if they have anything at all until they are dying and then the rest of us get that bill. This presumably saves money by avoiding preventative care and only having publicly funded care after there is a serious medical emergency. I will step off my large soapbox now and resume my place on the smaller soapbox.

ACA means something special to Professional Counselors.

The American Counseling Association (ACA) is a major organization in the counseling field. Most professional counselors, clinical counselors, mental health counselors, and so on are members of the ACA (American Counseling Association.)

If you are a counselor you should be a member of the ACA and/ or its local affiliate. Here in California that would be CALPCC. Some people are members of both.

If you are a counselor that sees people with Behavioral Health coverage under the ACA (Affordable Care Act) you should especially be a member of the ACA (American Counseling Association.) I am still not sure why we call emotional and mental illnesses “Behavioral Health.”

ACA is also for people in recovery.

Adult Children of Alcoholics (ACA.)

American Council on Alcoholism (ACA.)    

Adult Children Anonymous (ACA.)

And that’s not all the ACA’s.

One internet source (http://www.acronymfinder.com/ACA.html) lists 241 different ACA’s. This includes groups in Australia, Austria, Alaska, and Arizona. They also list groups of Accountants, Actuaries, and other “A” occupations. Just reading that list has started to make my head hurt.

We will leave our discussion of ACA there.

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 Route of Drug Administration?

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

Drugs.

Drugs.
Photo courtesy of Pixabay.

How many ways can you get drugs into your body?

While many therapeutic drugs are intended to work at various locations throughout the body drugs of abuse primarily exert their influence by their effect on the nervous system and the brain in particular. For drugs to affect people’s thinking, feeling, and behavior, to result in the classic substance use syndromes, the drug needs to somehow enter the brain.

The effects of a particular drug on the body and the user are hugely affected by the way in which the drug is placed into the body. Below are the primary ways drugs, therapeutic and drugs of abuse, are placed into the body, and some brief thoughts about the way in which these routes of administration affect the drug using experience.

Oral, swallowing, drinking, or eating drugs.

In the older drug use literature, drug eating was used as a term for many oral usages.  Tonics, elixirs, and soothing syrups often contained Opioids and alcohol in a drinkable form. Many drugs are still commonly taken orally. Alcohol is probably the drug that has the largest oral consumption.

Oral use is generally the safest way to take a drug as a portion of the dose is neutralized by digestion in the stomach. The drug will then be largely absorbed from the intestine into the bloodstream and then make its way through the liver before reaching the brain.

Smoking (inhalation) of drugs is common.

Smoking cigarettes is probably the first thing that comes to mind when we say smoking unless you are involved in smoking something else. Smoking results in a rapid uptake of the drug. Those lungs have lots of capillaries that were designed to take in oxygen but can be used to get drugs into the body also.

Many other drugs can be smoked. Marijuana is a close second to cigarettes. It may well move into first place soon. People also smoke crack cocaine and some forms of methamphetamine are smoked. Even heroin can be smoked. The trouble with smoking most of these drugs is that a lot of the chemical is lost in the process.

The result is that many, but not all, who start off smoking a drug eventually graduate to the needle.

Smoking can result in addiction very quickly. One puff and the level in the blood jumps up. It goes from the lungs to the brain and you really feel the hit. But the level quickly drops and leaves the smoker, of whatever drug, craving another hit.

There are other ways to inhale. Anything that becomes a gas can be sucked into the lungs and then to the blood and brain. Inhalants, sniffing fumes of gas, solvents, or other volatile chemicals is a type of inhaling.

Some things can be turned into a vapor without the burning part. Think vaping here but also there are ways to vaporize alcohol and breathe it in. Not recommended for home use as vaporized alcohol is also flammable and setting yourself on fire is a serious side effect of any drug use.

Snorting or intranasal drug use.

Cocaine leaps to mind here but other drugs can be snorted including heroin. Tobacco started out that way with people using powdered tobacco snuff. Snorting tobacco does not appear to make it any less harmful to your health.

Three ways to inject drugs.

When we say inject most people think the stereotyped heroin addict hunting for a vein to put the drug in, but there are plenty of other drugs and ways to inject them. Some of these are largely medical use but many drugs with a medical use are at risk to be abused recreationally.

Intravenous (I. V.)

I. V. Drug use puts a large dose of drugs into the bloodstream very rapidly. Beyond the risk from the drug, this method increases the risk of infection from breaking the skin and from the use of dirty needles. Sharing needles happens from necessity but also it is a part of the culture of some drugs that are used IV. This is the most common method for injecting drugs of abuse.

Intramuscular (I. M.)

This gets the drug directly to a muscle group. It is used medically for a number of reasons. In drugs of abuse, this is most often the way Steroids are abused.

Subcutaneous (Sub Q.)

Sub Q. sometimes called skin popping involves putting the drug under the skin. The drug, in solution, dissolves slowly and enters the bloodstream a little at a time. This works in a medical setting if the drug is very irritating and might be thrown up or when the volume of the drug is large.

Sublingual.

Some meds can be made fast-dissolving or even given as liquids. This is helpful for patients who are too ill to swallow pills. It is also used for some drugs to be taken at home when the patient cannot use needles.

Sublingual is the way chewing tobacco gets the nicotine into the system. Chewing drugs was the way native populations used Cocaine and Khat before refining and stronger forms came about.

Transdermal.

A few drugs or preparations of drugs can be rubbed on the skin and will be absorbed. For medications that really irritate the stomach and would be thrown up this works well. It also can be used when a particular area needs drugs applied locally.

Other (suppository.)

Where ever there is a pink mucous membrane there is a place where drugs can be inserted into the body. Who discovered you can abuse drugs this way? Maybe we do not want to know that one.

That is my quick summary of the various ways people place drugs into their bodies. Some are valuable ways to medicate people with serious illnesses but they can all also be routes of administration of drugs of abuse.

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 Antidepressant Discontinuation Syndrome?

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

What is

What is Antidepressant Discontinuation Syndrome?
Photo courtesy of Pixabay.

Suddenly stopping antidepressant medications can be a problem.

Antidepressant Discontinuation Syndrome is one of those issues that may bring a person in to see a psychiatrist, medical doctor, or occasionally even a therapist which is not technically a mental illness but it can cause all sorts of problems. Disclaimer here, I am a therapist, not a medical doctor. I bring this topic up because clients have a way of wanting to talk with their counselor about symptoms and possibly letting you know this could happen to you will put you on the alert for when you need to have another conversation with your doctor.

Antidepressant Discontinuation Syndrome is a group of symptoms that result when there is a sharp decrease in dose or when someone is suddenly take off antidepressant medication. This can occur when someone thinks their depression is better and they decide to just stop taking their meds. Clients have also reported this problem when they lost insurance coverage or could not get a prescription filled in a timely manner.

The DSM (See APA DSM) describes this as occurring when someone has been taking an antidepressant for over a month, presumably this means they have built up some level of tolerance to this particular medication.

The symptoms caused by this sudden drop in the blood level of antidepressant medication can include thinking, feeling, and perceiving problems. This is described in technical language as Sensory, Somatic, or perception problems. Clients have described this as seeing flashes of light, feelings of Electric shock, nausea, or sensitivity to lights.

An increase in or the occurrence of acute anxiety, generalized anxiety or dread are also reported symptoms.

This underscores the concept that tolerance and withdrawal can occur with many medications including over the counter and prescribed medications. Tolerance and withdrawal are not restricted to illegal drugs or drugs of abuse. The major difference between withdrawal from prescribed drugs and withdrawal from drugs of abuse is the presence of cravings.  Clearly, many prescribed drugs can also result in cravings when you are withdrawing from them.

Most people who would be withdrawing from antidepressants would not be expected to feel cravings other than in the sense of having unpleasant feelings they wish would stop.

If these symptoms are caused by side effects while on a constant dose, or as the result of being under the influence of a substance of abuse or withdrawing from that substance then Antidepressant Discontinuation Syndrome should not be diagnosed.

Some substance abusers have tried to use antidepressants to reduce the crash from drug withdrawals. This is not what we are talking about when discussing Antidepressant Discontinuation Syndrome.

How significant the Antidepressant Discontinuation Syndrome will be, depends on a lot of factors. The higher the dosage you are on, the longer you have been taking the medication the more the risk of experiencing Antidepressant Discontinuation Syndrome. Most antidepressants can cause this condition.

Antidepressant Discontinuation Syndrome is not the same thing as side effects.

This syndrome is the result of changes in the dose which results in a sudden drop in the blood level. Side effects happen while taking the prescribed dose as prescribed. If you have any unpleasant or unexpected side effects call your doctor right away.

The Antidepressant Discontinuation Syndrome take away?

You should never suddenly stop taking a prescribed medication. If you want to get off your meds or reduce your dose talk with your doctor first. Some medication needs to be tapered off slowly over time. A further worry is that suddenly stopping a medication that has been working for you may result in it not working later if you need to restart your meds.

P.S. were you looking for a number for Antidepressant Discontinuation Syndrome?

Used to be 995.29

Now is T43.205 the first time, T43.205D if it happens more than once, and T43.205S if Antidepressant Discontinuation Syndrome causes another problem (sequelae.)

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 are Substance-Related and Addictive Disorders?

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

What is

What are Substance-Related and Addictive Disorders?
Photo courtesy of Pixabay.

New ways of seeing addiction, substance abuse, and related problems.

Substance-Related and Addictive Disorders forms one chapter in the DSM-5 and reflects some shifts in the way people are thinking about both substances and addiction. Keep in mind that the APA who writes the DSM are Psychiatrists, medical doctors, and they tend to see these issues from a medical perspective. Substance Abuse or addiction counseling grew up as a distant step-child from the medical community and the two are still not in agreement on many of these issues.

Counselors and talk Therapists are likely to emphasize the emotional and behavioral consequences of drug and alcohol use and other behavioral “addictions.” Doctors emphasize the physical issues. Psychiatrists straddle this line but their primary method of treatment is prescription while the counselors are using talk therapy, behavioral modification, and support groups.

The DSM-5 lists 10 “classes” of drugs.

Any effort at classification ends up being a bit problematic. The DSM-5 reduced the list of categories from the eleven we had in the DSM-IV-TR to ten. It notes that these classes are “not fully distinct.” They are listed in alphabetic order so Caffeine-Related Disorders comes after Alcohol-Related Disorders. For Substance Use Disorder treatment, counselors often use some very different ways of classifying a client’s substance use. More on that in other counselorssoapbox.com posts.

What are the problems the substance is causing?

Each substance listed in the DSM-5 has sections for about 4 more or less different issues that this substance may be causing. Let’s use Alcohol for ease of explanation.

Someone may develop an “alcohol use disorder” and be referred for treatment of their drinking. The issue the counselor will be treating will be the client’s risky pattern of drinking that may include DUI’s, DWI’s, arrests, family conflicts, loss of a job, or even physical problems. The principle issue from the counselor and the client’s point of view is the client’s inability to reduce or control their drinking, the presence of cravings, and their use even when they know it is causing problems.

Substances can hurt you even if you do not take them intentionally.

The DSM includes provisions for the medical practitioner to diagnose and code problems related to substances that a counselor is unlikely to treat. Lead poisoning is a serious medical problem, so are the side effects of prescribed medications. Neither of those is something the counselor is likely to treat.

What problems might a substance cause someone?

  1. A substance use disorder where their use is out of control or they have carvings.
  2. Intoxication, the effects that we see while they are under the influence.
  3. Withdrawal. Unusually withdrawal effects are the opposite of intoxication. Stimulants keep you awake and withdrawal from stimulants will involve being tired and sleeping a lot.
  4. Substance-induced disorders. These are medium to long-term changes that are the result of exposure to a substance that persists even after the drug has left the client’s system.

What are the 10 listed drugs?

  1. Alcohol
  2. Caffeine
  3. Cannabis (Primarily Marijuana)
  4. Hallucinogens
  5. Inhalants
  6. Opioids (Heroin and RX pills)
  7. Sedatives, Hypnotics, and Anxiolytics.
  8. Stimulants. (This combines Cocaine and Amphetamines, the DSM does not separate Meth from other amphetamines the way substance abuse treatment does.)
  9. Tobacco
  10. Other or Unknown Substance Use Disorder

Non-Substance-Related Disorders.

Towards the end of the Substance-Related and Addictive Disorders chapter, there is a section for “Non-Substance-Related Disorders. That section includes a single entry for Gambling Disorder.  In counseling work, we see things we may conceptualize as behavioral addictions, sexual and pornography addictions for example. These are not a part of the DSM-5 Non-Substance-Related Disorders section.

The Substance-Related and Addictive Disorders chapter shifts the focus.

We used to spend a lot of time arguing about the differences between addiction and substance abuse. People with a DUI would tell us they did not need treatment. Now the DSM largely drops these labels and if you have any problem with a substance that becomes a substance use disorder. We rate the use disorder as mild, moderate, and severe.

Remember that the Substance-Related and Addictive Disorders are listed in the “Diagnostic and Statistical Manual of Mental Disorders and these are largely considered treatable mental illnesses. The medical issues have other codes and are outside the scope of practice of a counselor, though we may need to help them adjust to the consequences of their medical issue. Watch for more posts on these other related issues.

As with the other things we are calling a mental illness these Substance-Related and Addictive Disorders 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 a preference, not a problem.

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.

You might also want to check out these other counselorssoapbox posts.

Drug Use, Abuse, and Addiction

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 Abstinence Syndrome?

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

What is

What is abstinence syndrome?
Photo courtesy of Pixabay.

How is Abstinence Syndrome different from withdrawals?

Abstinence syndrome is a group of symptoms that occur when someone is suddenly without a drug that has previously been in their system. In substance abuse counseling this term is often interchanged with the term withdrawal. Withdrawal from Heroin or related drugs is the classic example of withdrawal or abstinence syndromes.

Generally, the symptoms seen in withdrawal or Abstinence Syndrome are exactly the opposite of those experienced while under the influence. Opiates such as heroin, for example, are very constipating, people in opiate withdrawals encounter diarrhea. Less dramatic symptoms may go unrecognized as withdrawal symptoms.

Someone who uses sleeping pills may experience insomnia when they stop taking the medication. Discontinuation of Anti-anxiety medications may result in a rebound of Anxiety. If you smoke marijuana to relax expect to be more anxious or agitated than before when you discontinue smoking. Coffee drinkers have almost universally experienced headaches when deprived of their regular dose of caffeine.

Abstinence Syndrome has taken on added meaning when applied to those who do not intend to withdraw but are deprived of a drug they have become dependent on. Newborn infants may experience an abstinence syndrome from drugs which they were exposed to pre-birth. Neonatal Abstinence Syndrome is a term commonly used to describe babies born to women who were dependent on opiates, principally heroin or prescribed opiates.

People who stop taking or have a sudden decrease in the dosage of their antidepressant medication can develop a very specific type of abstinence syndrome called Antidepressant Discontinuation Syndrome. More on Antidepressant Discontinuation Syndrome in an upcoming post.

Animals can also undergo abstinence syndrome when they have been administered a drug and then it was withdrawn.

Many people will deny having ever had withdrawals from a drug, but almost everyone has experienced Abstinence Syndrome when they were deprived of a chemical they use on a regular basis, such as caffeine, sugar, or nicotine. In terms of Substance Use Disorders, Abstinence syndrome and withdrawal are about the same thing.

These “What is” sometimes “What are” posts are my efforts to explain terms commonly used in Mental Health, Clinical Counseling, Substance Use Disorder Counseling, Life Coaching, and related disciplines in a plain language way. 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 the Addiction Severity Index (ASI)?

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

What is

What is the addiction severity index?
Photo courtesy of Pixabay.

Assessment in substance abuse counseling has a different focus.

The Addiction Severity Index (ASI) is an instrument that is used in assessing the extent of a substance use disorder that has resulted in someone being referred to treatment. Sometimes it may be required by a governmental agency to help them determine if they will require a person to undergo addiction (chemical dependency) treatment. I have written elsewhere about the shift from the terms addiction, alcoholism, and chemical dependency to the new DSM-5 term Substance Use Disorders. See recommended books for more on the DSM-5 and the APA.

The ASI is a proprietary instrument, if you use it commercially, you need to buy it from the owner or license an online version. You can take a look at a sample at ASI Training Edition.

The primary goals of the ASI are, as I see them, to develop a comprehensive picture of the client’s alcohol and drug use and how this use has affected other parts of their life. Once you see what substances they have used, how much and for how long, you can more effectively move on to exploring the parts of their life that have been affected by substance use and abuse.

The ASI can be used to develop a comprehensive treatment plan. Recovery involves a lot more than just not using substances. The client may have many aspects of their life they need to work on to stabilize that recovery.

Areas of concern on the ASI include medical issues, employment, and financial issues, legal issues. Specifically, crimes, incarcerations, and parole or probation status are areas of concern.

Relationships with family, friends, and primary sexual partners have all likely been disrupted or created by drug-using affiliations. The last area the ASI explores is psychiatric issues. This page of the ASI is brief and is not intended to diagnose mental illness but having yes answers about symptoms on this page is common.  Mental health symptoms reported on the ASI should trigger a longer and more complete psychiatric evaluation to look for issues that may impact substance use or have been caused by that use.

Is the ASI a good assessment tool?

In my opinion, the ASI is a useful tool but like any other tool, the skilled craftsman gets better results from it than the beginner.

When I mentor beginning counselors I caution them about over-reliance on an assessment form. Whether you are using the ASI, a biopsychosocial assessment form, or any other one, the form never gives you an absolutely full picture of the person. Clinical psychologists not only give “batteries” of tests but also spend a lot of time learning to interpret those tests.

The difference between a good assessment and a just so-so assessment is not the instrument you use. If the client says something unexpected I like to follow-up with more questions. I want to know what the client thinks about this item. The really good counselors who use the ASI also include some “stuff” in the comment sections where they tell me more about this person. When I read a client’s assessment I want to know more than just which boxes got checked. It helps me and them if the assessment paints a clear picture of the person and their problem.

If you’re doing assessments, make more comments so we can better help that client. If you are the one being “assessed” the more you tell that clinician the more they can help you.

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.

You might also want to check out these other counselorssoapbox posts.

Drug Use, Abuse, and Addiction

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 Abnormal Psychology?

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

What is

What is Abnormal Psychology?
Photo courtesy of Pixabay.

How is Abnormal Psychology related to mental illness?

Abnormal Psychology used to be a chapter in psychology tests, sometimes it was a separate class. Personally, I am becoming increasingly uncomfortable with the whole idea of normal versus abnormal when it comes to psychology.

We used to think there were two kinds of people, normal and abnormal. Presumably the abnormal had something wrong with them and the rest of the people were just fine. The more we study people the more convinced we become that there is a very wide range of what is normal.

Wikipedia has an extended discussion of Abnormal Psychology, though as a note to students be careful with this article, it is not up to date on the recent changes taking place in the field of mental health. For example, the DSM-5 has eliminated the use of the five axes system.

The working definition Wikipedia is using, at least as of today, appears to be more in the realm of “unusual behavior” as opposed to what gets diagnosed as a mental or emotional illness. In psychology, there is this tendency to look at behaviors as either adaptive or maladaptive. In mental health, we think that “adaptive” may well be in the eye of the beholder.

Think back to that “bell-shaped curve.”  When people are so variable how are we to tell how abnormal is abnormal? I have written elsewhere about how along the way psychology and counseling, mental health, in particular, got a divorce. Rather than try to figure out whether atypical ways of thinking were “abnormal” we are looking at – does this different way of thinking help you, as in Steve Jobs or Bill Gates, or is this abnormality hurting you.

So the criteria for calling the behavior a mental illness is not that it’s an abnormality, but does this behavior, normal or not bother you, interfere with your working, school, or relationships, or does it interfere with other important areas of your life, like hobbies and so on.

The criteria for mental illness are about functioning and how do you feel about yourself. Those kinds of things. It is not about are you left-handed or extroverted.

People are not abnormal all the time about everything.

You can be very different about one thing and quite typical, I hesitate to use the word normal here, about other things. People can move around on this continuum we call recovery and wellness. So being abnormal about one thing, today, does not mean this abnormality applies to everything all the time. Even if it did, this is not necessarily a bad thing unless you think it is.

 Will studying Abnormal Psychology fix you?

Lots of students, typically first-year ones, find they are having emotional problems and they take a class in psychology, maybe become psychology majors, thinking this will “fix” them. They learn a lot of stuff but usually, none of this helps with the problems they are having.

Much of what you experience in life has to do with developmental stages. That high school to college transition can be a difficult time. Lots of stress, the competition to do well. There are also those things about getting into relationships, trying out drugs and alcohol, and figuring out who you are.

Some people get through, pass this hurdle, and some do not. Rarely does knowing that you are introverted or extroverted or exploring your thinking, knowing, perceiving, ENTI or other psychological theories help explain your depression or anxiety.

That normal think just does not always explain why some people do what they do. Really odd people become great successes and very normal people get angry about their partner’s behavior and show up at worksites with guns.

If you are feeling “different” consider talking with a professional who can explain what kinds of abnormal are OK and what kinds deserve treatment. No, you do not need to be crazy to get counseling. In fact, if you are having problems it makes sense to get help.

These “What is” sometimes “What are” posts are my efforts to explain terms commonly used in Mental Health, Clinical Counseling, Substance Use Disorder Counseling, Life Coaching, and related disciplines in a plain language way. 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 Acetaldehyde?

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

What is

What is Acetaldehyde?
Photo courtesy of Pixabay.

The more Acetaldehyde the sicker you get.

If you have ever had a really good time, drank a lot of alcohol to celebrate, and then experienced a hangover afterward you can in large measure thank Acetaldehyde.

Acetaldehyde is the first breakdown product as your liver starts to go to work on that alcohol. You and your liver are not in agreement on the consumption of alcoholic beverages by the way. For the liver, not much is worse than alcohol. So no matter what noxious, poisonous, or even used and expendable chemicals your liver detects it generally goes to work on the really bad stuff, meaning alcohol, first.

The first time your liver experiences alcohol it may be mystified by how this poisonous substance got into the bloodstream. But it will quickly gear up and produce ever-increasing amounts of alcohol dehydrogenase (ADH) the enzyme that breaks down the alcohol.

This first step in the processing and elimination is why disulfiram, trade name Antabuse, by interfering with that first step in the breakdown, makes people who take disulfiram become very sick when they drink. The theory was that this would be an adverse experience that stopped the person with the alcohol use disorder from drinking. In practice, those with an alcohol use disorder will avoid taking the med or they will endure the adverse effects so that they can still drink. Disulfiram has helped some people but it does not seem to be the magic cure we had hoped for.

Men’s stomachs produce some ADH, you ladies should know that your stomachs produce little or no ADH. The result of this gender difference is women get higher doses of alcohol entering the intestine than men do even if you drink the same amount.

Once the alcohol is broken down to produce acetaldehyde the liver kind of kicks back and takes its time working on that acetaldehyde. Turns out that the acetaldehyde is more poisonous to the body than the alcohol was, but it takes more time for your liver to gear up and get that stuff broken down.

So despite all those hangover remedies, you will need to wait while your liver prioritizes the processing of the alcohol before it gets going full steam on the Acetaldehyde.

Eventually, your body will produce other enzymes related to ADH to break down the acetaldehyde into acetic acid and then ultimately that will be processed into water and carbon dioxide. The liver has only one speed when it comes to using ADH to break down Alcohol. No matter how much alcohol you put in the bloodstream your liver just works at its one speed. This whole chemical manufacturing process going on inside your body just takes time.

Putting up with the hangover is just a small price to pay for having a liver that works so hard getting all those toxins out of your body.

Please treat that liver well because if it ever gets damaged and goes on strike your whole interior neighborhood will become polluted and eventually your body may become uninhabitable.

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 – “What is?”

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

What is

What is?
Photo courtesy of Pixabay.

Sometimes words don’t mean the same thing to all of us.

The fields of counseling, therapy, and psychiatry all have some common interests but we don’t always use the same words to describe the same thing. Add in related disciplines like psychology, substance abuse counseling, self-help, and life coaching, and the field has become a veritable tower of babble.

If you are struggling with, or in recovery from, a mental, emotional or behavioral disorder or if you have a problem with drugs and alcohol you may wonder what the words you hear mean. Many of the people who arrive at the counselorssoapbox.com blog have used a search term looking for information or trying to find out what a particular disorder or treatment word means.

Students in the classes I teach and sometimes the interns also, appear to grasp the concept but then come time for the test and they miss things I thought they knew. Recently I have gone to ending many nights class with a slide about the words, possibly new words, that were used in that night’s lesson.

It occurred to me that it might be helpful to explain some of the terms that professionals, researchers, self-help writers, and recovering people use. As time permits there will be posts about all these and other topics.

Not everyone agrees on the definitions of these terms. Some of the labels we use come from the American Psychological Associations book Diagnostic and Statistical Manual of Mental Disorders (DSM.) The most recent version of this book is the DSM-5. Another source of labels used in the mental health and related fields is the World Health Organization’s International Classification of Diseases. The most recent edition of this would be the ICD-10. The ICD-11 will be on the scene soon.

Descriptions of terms that will be in this counselorssoapbox.com What is — a group of posts will be my “plain language” versions of these ideas.

The plan to describe and discuss things from the simplest possible perspective so I will paraphrase or use metaphors to explain what I am talking about. For the full text that defines mental illness see the appropriate manual.

Writing all these posts will take me some time but then you were expecting that weren’t you? This group of posts will not necessarily be in alphabetic or any other particular order. I write them as the muse strikes.

As always, comments are welcome, some end up being the basis for future posts. Remember there is only one of me and that I write during that rare period known as “spare time” therefore some comments will get faster replies than others. My goal is to respond to all of you eventually.

If you made it to here, thanks so much for being such a dedicated reader.

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

School is back in session.

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

School classroom

School

School went back in session which means all things work-related have changed.

With school back in session, I find my schedule has gotten way busy just at the time readers are checking out the blog and leaving comments. I believe that because of the topics I write about, mental health, substance use disorders, and co-occurring disorders, more searches are happening just now on those topics. Some of this is school-related.

This time of year, at least here in the northern hemisphere where I live, people start abandoning their outside activities and return to their indoor life. This shifts the attention from fun activities to relationships, careers, and where their life is going. So more interest in the winter, indoor months, in happy life, self-help, self-improvement, and relationship issues.

As a result of this increased interest, my list of topics to write about has grown longer while my time to write has been reduced. My teaching and counseling work schedules are keeping me busy just now.

So please forgive me if it takes some extra time to respond to comments and questions and if occasionally there are some gaps in the publication schedule.

Counselorssoapbox.com is approaching one thousand posts and still growing. Thanks to all of you for reading and continuing to be supportive of this endeavor.

What is ahead for the coming months here on counselorssoapbox.com?

A new feature coming up will be a series of posts titled “What is.”  This started as a project for my beginning students and the masters level people I supervise. Knowing the vocabulary of mental health and recovery helps them think about what they will be doing and the issues in the field. These “What is” posts will be shorter than the regular long-form ones.

The field is changing, counselorssoapbox and the posts on it need to reflect those changes. We are looking at milder cases of issues and the topic of prevention. The old idea that the mentally ill, addicts, and alcoholics were fundamentally different from “normal people” has given way to seeing how anyone can at times have a substance use disorder when their drinking gets excessive and that you can move back and forth on a continuum of mental wellness.

The year ahead, academic not calendar year will need to include more posts on wellness and recovery, and some things called strength-based recovery. Parallel with those new ways of thinking is the emergence of non-medical counseling and coaching. All of these areas are fertile topics for thought and discussion.

Those who know me well, know that I love seeing clients, teaching, writing, and supervising new counselors, because I learn so much in the process of listening to all of you and researching the topics I will write about.

Hope you will all continue to follow counselorssoapbox and thanks for your continued support in all I do. Keep those comments and questions coming and I will do my best to share what I know or can find out about those topics.

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