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vicarious trauma vs burnout
Vicarious Trauma is the secondary effect of the therapeutic process and is intrinsic to good work. Empathy is the foundation of all successful practice. Empathy comes with listening and grows in depth and intensity over time with focused application. It can look like burn out but it is fundamentally different. Burn out is an over-application of energy or a lack of appropriate boundaries or limits or even a lack of self care. Vicarious Trauma comes with the job. The people who show up for treatment are almost always the walking wounded. Horror scarred trauma survivors who need someone to listen to them and feel their pain. Ask them questions about solutions and when they’ve done well and tell them they can do it. This is not without cost.
We know how empathy works in the brain. If you are given an electric shock certain brain areas light up on an f-mri scan. If you watch someone given an electric shock the same areas of the brain light up. Mirror neurons i think they call them that underlay our theory of mind. how we get into other peoples heads. What if you are an artist of getting into peoples heads. Maybe the negative energy would build up in you all day, almost every day so that by the end of the week you almost tingle with bad vibes.
Other peoples stress hurts your back and you feel that if you might be touched all you could do was shudder. You might become estranged from your own body and be soul sick empty. It might go up and down as your ability to tolerate it grows and becomes depleted from circumstances, real life events, that sort of thing. You might become afraid to handle it. shake it off. work it out. allow it to pass over and through you but not be you. maintain a core inviolate. but what if that just leads to ratcheting up the pressure. more. more. more.
I know what i can take and how much is good for me and i am solidly in the middle between the two. the only time i’ve worked in the field and not held symptoms of burn out was with cortez. i worked maybe 32 hours a week. 2-3 groups and maybe 10 clients, seen once weekly. i took a 4 day weekend every month, a week off every season and a month off in summer. i set my own schedule.
but i made squat and poverty has stresses of its own. the world is not organized this way. the world expects 40+ and more hard hours. i love being a clinician but it is not good for me. not in this world. but i’m learning and remain cautiously optimistic that i can find a way through the apparent inherent contradictions and do great things in a less costly way. Definitely success, people getting better, making a difference, more positive feedback then is good for me, is a counterweight to the hurts and pressures. my self care of course has a lot of room for improvement and that is probably where i need to go. the only factor really subject to change because it is under my power. gratitude of course. its whats carried me through this week til i ran up short feeling estranged and worn out but happy too at happy hour. putting it out there feels good too. i’m hesitant to share about my days unless they’re good. but one good thing about this space i don’t fear trouble. i am way beyond that.
interventions for co-occurring mental health symptoms
wasn’t feeling well today. a day of rest behind me and i don’t feel substantially better. will allow the days events to carry me through. feeling better then the neighbor though i imagine she was just taken away by the police. that is never really a good thing. it was the campus police which always weirds me out because their cop cars say “Mu Police” which always makes me think agents from the lost continent are prowling about.
i am watching the tigers game, up on the whitesox by 2 in the 3rd. planning on doing a little work. I have a training i am doing on wednesday and i swore i would write a handout. as per usual i like to do my creating on my own time in my own forum so that i own the fruits of my labor. plus work is a terrible place to try to create. you need space free of demands to make something new. mostly my work creativity is drug out me responding to situations. allowing solutions to develop.
if your a new reader i am a counselor at a substance abuse treatment agency where i coordinate some of our mental health programming and staff training. i have been trying to increase the counselors comfort in helping individuals with co-occurring mental health disorders because its way to common for me to handle all those folks.
Integrating Co-occurring Disorders Treatment into Substance Abuse Counseling Sessions
Principles:
The client is the biggest expert on their situation. You don’t have to know anything about the disorder to help the client manage it. So tell me about disorder X? What does it mean for you? Is there a time when it has been better then other times? What was that like? What did you do that made it better? Oh, that sounds like a good idea, do you think we could try that again?
There are no magic wands or “experts” who can do substantially more then you can. When I was a young clinician i referred out most tough stuff but when i did follow up contacts i learned that those referrals that were so hard to hustle up rarely yielded results. Appointments don’t get made, eligibility changes, someone doesn’t get engaged, there are endless ways that things go wrong. I began to notice my simple interventions were usually the most helpful thing. If you’ve got them engaged then likely no one can help them more then you can.
Mental illness is a concept with a lot of give and uncertainty. They can be thought of as nothing more then names we give to clusters of symptoms. Breaking down what symptoms are occurring and developing separate management plans for each symptom can be tremendously helpful.
Data is really useful and collecting it is good for you. Documenting negative behaviors decreases their frequency and the data collected can point to management strategies.
Treatments that people believe in are more effective. Treatments that individuals believe will not be effective will not be effective; we call this the Nocebo Effect and it is real and measurable and more powerful then morphine. Present yourself in a hopeful and confident manner, share some brief success stories.
Listening is still the most helpful thing you can do for someone. When someone tells their story to a supportive listener their self efficacy increases. A rising tide lifts all boats. Validate their struggle.
Techniques by Symptom:
Depression: Sunlight and exercise. Reframing. Separating feelings from behaviors. Cognitive approaches.
Mania: Catch it early. Sleep every night. Progressive relaxation.
Impulsivity: Slow things down. Strengthen powers of reflective thought. Keep long term goals in working memory. reward curbing impulses. work on something that happens all the time and then generalize.
Hallucinations/Delusions: Ask if they know if its real or not. If they do tell them don’t attend to them or give them energy. Learn to ignore it. Shift to the concrete. Never feed into it or ask for unneeded details. If they can’t tell its real they have to ask people they trust.
Paranoia: note if they describe it as such, it means they know its not real. If they truly think people are out to get them de-escalate and reassure.
anxiety: cognitive approaches work well as does data collection. scaling and exposure are the classic approaches. de-escalation and teaching self soothing is also key. exercise.
attention deficit: point out there are times they can pay attention. measure them and grow them systematically with rewards.
OCD: cognitive approaches.
suicidal ideation: ask, contract, normalize
SIB: validate as a valid coping mechanism, identify healthier coping mechanisms
Sleep Problems: exercise earlier in the day, cut back on caffeine, routine, progressive relaxation, Trazodone
Nightmares: Propranol,
Finding a doctor: Primary care is not a bad place to start they use less psychiatric medications in lower doses which can be a good thing for patients with addiction. If no insurance contact the Family Health Center (214-2314)and ask for the medical social worker for a referral to Medzou. If you frame it as a psychiatric issue he may not refer.
The Phoenix psychiatrist is reserved for existing patients and MAT evaluations. Good candidates: have no insurance, are alcohol or opiate dependent, have had numerous treatments, are willing to do aftercare with Phoenix for the long haul.
adventure can be inspiring
Its a hot day outside and enjoying some rare ac at home “relaxing and enjoying the work of justin verlander” to use the commentary without the expressed written consent of major league baseball. Its a slow game though and with only evenings and weekends for entropy control and to advance projects it seemed a good time to blog. as i said a post or two ago i am committed to blogging weekly if for nothing else to give the computer enough time online to do updates. i feel like my last couple read like that too.
Overall, i’ve been a little low energy which is not unexpected but inconvenient as the world expects me to jam, all day almost every day. i’ve been on top of that but not much else, personal life items i’ve left without the attention to detail and positive effort they require. but today i am tired but a good kind of tired. not as tired as verlander, its 98 in KC and he’s over the century mark and a fast hurler. in his defense he’s in much better shape, which sort of relates to what i’m going to be blogging about. adventure can be inspiring.
friday i lit out of work right on time and threw some things together for a float trip with eric and trevor. we were going to go camp somewhere close and then float the grand, conditions permitting. [verlander’s getting some rest after an inge error cost him his shut out, there’s bases loaded with a 1 run lead] i loaded a lot of stuff since i had the space and time and wasn’t exactly sure what the camping would be like. i also gave everything a good solid drink in the garden because it was supposed to be hot and stuff was thirsty. i also found this ginormous tomato horned worm and squished him. he’d done some damage and i feel like there’s at least another one but i can’t find him. maybe tonight when its in the shade.
at close to 6 i decided i would see if i could load the boat. if you’re not a regular reader i have short and stubby plastic canoe that slides nicely into the back of the popster’s f 250, one strap and its secure. its really growing on me. my brother got it for a float with smokey down the big muddy and its both short and has a huge keel which makes it maneuverable for a solo boater. also makes it convenient not to have to strap it on top. plus people are always impressed with all the cup holders. john calls it “the Cadillac of cheap canoes”.
but i never got to see if i could load it myself because mark, who i knew was a possible drove up and helped me load it and ably strapped it down. i have a thing about scraps and am majorly inept for having been dealing with them my whole life. its probably a complex but i’m almost 500 words into this post and haven’t even left yet so i got to pick up the pace. mark followed me over to trevor’s and we had a PBR in the front yard and strategized. the grand was flooded and there was no nearby camping so we decided to do locust creek through pershing state park. [the royals announcer gave a nice run down on victor martinez, he came to the tigers not up to potential, got in ‘short stop shape’ and this year he’s an all star. cabrerra has also dropped some pounds (but he was a monster last year big as a house)]
mark rode up with me and it was nice to reconnect as we both have been through some stuff and could relate and we had a good talk about grief. we stopped in macon for mexican food. i got alleged tamales which were either these little deep fried things which were pretty good or a mass of corn meal with an array of chicken and hamburger. not bad but not tamales. i also realized i forgot fido’s bowl, remembering i had let it be when i thought to pack it in case he wanted to eat before the treat. i walked over to walmart and got some iam’s little dog cereal and a couple of other things.
so with all that we rolled into pershing state park pretty late. it was an rv kind of park but the entrance was empty so we were off by ourselves and they have showers. not bad really for $11 i think for a nonelectric site. i didn’t want to chance setting up the tent not really knowing if its mine. john and i both had Marmots and he had packed up the camping stuff conflating our things and i couldn’t remember what model i have. so i decided to just sleep on the cot which was a bad idea from the start because of the mosquitoes and not packing a sheet. plus the raccoons were persistent and fido was barking and facing off and i didn’t get to sleep until they called it a night at sunrise, except for the four stuck in the dumpster. [valverde holds the lead and the tiges go into the all star break in first beating out the hated cleveland racists] so maybe 2 hours sleep tops.
but i woke up a little groggy but feeling good. eric makes this coffee concentrate and i mixed it strong and everyone enjoyed the can of condensed milk i broke out. a camping trick i learned from the popster who liked to live large. it was also good with the oatmeal mark made with lots of chopped almonds as it sweetened it up a little. i read the paper and drank my coffee and felt human enough to do the dishes. we drove south to find a pull out, checked out a little iron bridge and talked to a local who didn’t know anything about floating conditions. we drove south and found a spot and left the red truck.
we drove up to 36 i think and went west to the first pull off and found a good put in place. this is norther missouri bottom land. flat and rich mostly agricultural. there’s a nicely maintained riparian zone down the creek and it was muddy but of a goodly size. trevor saw a flat turtle and we both encountered a snake at the first log jam. it looks like he was fishing were everything just suddenly comes to a halt. we looked around and he disappeared. we ended up with a fairly lengthy portage which we did with good sport and a lot of gratitude as we ran into some really great wooded wetland with some really big old beach trees that certainly predated settlement. they didn’t look as big as the biggies in the spot of alleged old growth in Houston Woods in Ohio but they were really good sized and it was a mature forest.
we pushed through both poison ivy and stinging nettles to get back to the creek and were glad to get in the water and ended with no ill effects of either except from some nettle-itch at the time which is invigorating if you can look at it right. we ended up having 2 more portages and saving a third one by lifting the canoe over a fallen log at the third obstruction. nonetheless we all had fun and the portages made it more of an adventure, our own voyage of discovery and a good time was had by all.
especially fido who enjoyed his first float. he enjoyed being off leash as we scouted pull outs and put ins and had been on a swim and was reluctant for me to grab him up and throw him on the canoe. He jumped out once preferring to swim or run along side but he got used to it. we stopped to pick a couple of ripe blackberries (in a week or 2 it will be an excellent float with a lot of berries pickable by boat. I had fido on a leash when we picked berries or he would have abandoned the expedition.
I bet he’s glad he stayed though cuz we hiked in out of the way places, swam when we got hot. one nice place had a shady log and there was one of the few bluffs and the creek had carved out a nice deep swimming hole. fido swam across even though it was wide and deep with a strong current. he is a doughty sailor dog just like bichon frise’ are supposed to be. we had lunch really great cheese and avocado on black bear bakery bread which were very yummy. i wish i would have brought my first tomato though, although we may have that for dinner tonight. kevin made hummus and tabbouleh.
at our lunch stop i really struggled. i sank into the mud up to my knees and lost a shoe and was really stuck for a minute. had to have help to scramble up the muddy bank to the luncheon log. it really struck home my desire to get into better shape and the need to be way more on it now that i am getting older. i’ve been cutting myself to much slack for having a hard life and still need exercise more and eat better. i was more convinced when i was the only one that was completely done in (except for fido) at the end of the day. eric was kind enough to drag my boat out and carry it up to the truck.
but the adventure was fun. it could have been an ordeal which that uncertainty is a prerequisite of adventure. we were all resourceful, flexible and laid back so we would have rolled with whatever and made it work but it was big enough to be a challenge but doable enough to be pure fun. we all enjoyed some country cooking and had the buffet and i ate good. but not so good as has been my habit of late.
been pretty on it today too. slept hard and good and woke up refreshed and feeling like i’d done something. drank coffee and read the paper. roasted my first batch of beans, an ultra-light Guatemalan that looks awesome and i’m eager to try. i’ll let you know in a day or two how it is. then i mowed the back yard before it got to hot, got some laundry hung and made it to the wabash farmers/art market. got some sweet corn, cucumber for the humus, and some peaches (pricy but good). decided to skip malick’s new one but saw it was playing through thursday so i might still catch it. been thinking about asking someone out. haven’t done that in many years.
Four “A”s
I am putting together a new group for work and as always I prefer to do my creative efforts at home in my own time. I have always worked that way finding the day to day grind and meeting responsibilities, deadlines and helping people makes work fairly frenetic most of the time and not a great space for thoughtful creative enterprises. I’ve had my best therapeutic insights, come up with a new approach to a stuck problem in just musing on it a bit on my own time. When I was married I would get checked for not leaving work at work but if you enter the helping professions sometimes a little more is asked of you. I don’t fret about work, worry about my clients, or beat myself up over outcomes. I do sometimes brainstorm, ponder, muse, pray for the people who are struggling who cross my paths. Its part of caring about people.
I also like to do my creative thinking at home so that I continue to own my own thoughts. If I were laying this out on my office computer on the clock then there would be every expectation that the fruits of my labor would belong to my employer. Now I am pretty much anti-copyright but I would hate to see a situation where I don’t have access to my own ideas because someone else owns them. So most of my original stuff makes its first appearance here.
The state of Missouri pays substance abuse treatment agencies for two types of groups, education groups and process groups. Education groups you teach something and that is my preferred mode of operation. Education is not a particularly effective intervention for people struggling with drug abuse and addiction. Most of them know drugs and alcohol can be bad and recovery can be a road out when you’ve lost the ability to find your own way. Motivation is actually the name of the game and so education groups have become an opportunity to grow my motivational speaking abilities. Its more akin to preaching then teaching and has been a lot of fun.
Process groups are group therapy. In education groups I make my personality very large and in process I make it very small. I start each group with a check in. Your name and how are you feeling. I point out identifying and resolving feelings is key for recovery. Rather then provide a feelings list (there are many if you google them) I want to stimulate creativity and honest expression I just ban a few meaningless pleasantries: good, fine, OK, & alright. I also ban “tired” as a body feeling and rarely an emotion. Then I define what process means and ask people to do it, sit back and watch. Nod, call on people and ask questions when no one is talking. If everyone didn’t participate I do a check out of what stood out in treatment today?
It works fine, have heard many times, “that was the best process group I’ve been in”. But my new slot is 7:00 pm, much too late for an unstructured member driven process group. So instead I want to do something highly structured that is still a group process activity. I have been kicking around a self help/social change group for many years. This seems an ideal time to kick it off. I am going to call it an Accountability Group and organize it around what I call the 4 “A”s: Awareness, Assessment, Action, and Accountability. I thought about calling it 4 A or AAAA as well. It will be set up on a level system and to go with the 4 “A”s there will be 4 life areas: physical, mental, emotional, and spiritual.
We’ll begin the group with a check in and perhaps expanded introduction. The first week will be all about Awareness which begins the change process. Identification and informal observation.That can last one week to forever. Out of that Awareness we will develop Assessment tools to measure and create a baseline. Usually for two weeks. Out of that data an Action Plan will be developed. Accountability will come from the group as well as mutual support and the sharing of ideas.
I envision a 16 week process and leveling people up as they get things done. Making it easy to start, just be aware but making the next levels having concrete achievements tied into it. After you move through the whole system for all four areas you are ready to start your own 4A group. We’ll develop tools for each level and documentation and accountability systems collaboratively over time.
January’s done
Hello faithful readers. Sorry I have not been posting. January was a challenging month and I continue to have some computer problems that I haven’t felt like dealing with. I also had my boss talk to me about a negative mood state I incidentally mentioned and that has had a chilling effect on what I want to post about. Now I see why more people don’t have an honest and revealing blog. Nonetheless this is a periodic blog and so regardless of the consequences I am going to periodically blog something. Today I am up early waiting for the snow to start. We are awaiting Columbia’s first blizzard warning. 18″ to 22″ by tomorrow noon. We have gotten a lot of snow this winter and I have been really enjoying it.
My New Year’s resolution was to work on getting in better shape this year. I started with weigh ins on most days and writing down everything I ate and all the exercise I did. A solid plan that started out nicely but as the month continued I started to get depressed and decided this was not the time for any volunteer upheaval in my life. I am stretched to meet the things I need to do. The only piece I kept was the exercise peace. If you know me at all I am not one for the gyms. I enjoy real physical activity that is purposeful and utilitarian, so mostly I walk. Almost every day. The weather really challenged that this year and I have risen to the occasion and gotten out there anyway. Its been really cool getting out on the bear creek trail and seeing no tracks but what fido and i laid down on our last walk.
Sidewalks have been my obsession. Most people don’t shovel here in Columbia, which offends my Michigan sensibilities where almost everyone does. It makes it a lot more challenging when you get pushed out into the road, especially with a small dog. The alternative is to push through deep snow on the sidewalks. Fido wears out pushing through chest deep snow on a steady pace the leash demands. He’s great off leash. He leaps and hops and catches his breath and continues the mad dash. He can run circles around me, literally, but can’t trudge. So when he is exhausted before the trail and we have to turn around and go home, probably walking down the road with car’s not slowing and some not even looking up from their texts it frankly pisses me off and has been a source of rancor all winter.
I want to approach McKnight plaza as a concerned neighbor. They have a lot of sidewalk and if they shoveled it would have a huge impact on the neighborhood. It would even be in their own interest and not just a community service. They are trying to lease a big chunk of it and if they shoveled it wouldn’t tip their hand that their isn’t a lot of foot traffic. If the sidewalks were cleared there might in fact be foot traffic. I would approach them as a faithful Itchy’s customer (awesome flea market) but I feel like a hypocrite with my work’s sidewalks unshoveled across the street. I almost shoveled them myself and looking back I wish i would have. Feeling a need to do something and not doing anything is not a good way to feel better about something. With the blizzard coming I don’t know when i’ll be able to get out with the little dog. After knocking out my driveway I might just walk down the street and knock it out at work. then i might give Mcknight a call.
Writing this I can see I’ve lost all perspective. little things can loom large in the narrowing of winter. Dad too has been down. Dennis’s birthday on the 15th has historically been a hard day. Less so over the years but this year seemed tough. With Mom’s b-day coming up on 1/31 i was a little concerned. Talking it over with a co-worker she suggested we do something special. So last night we went to Outback Steakhouse. On one of my folks’ few vacations they had gone to Branson and loved Outback. It made what could have been a tough day kind of festive and a time to celebrate. Not a bad recipe for most difficult things.
Low Car Challenge
Every September Columbia has a No Car Challenge where participants agree not to drive or ride in motorized transport that is not the bus. I’ve wanted to do it since I got here and this year I was able to do the Low Car version where I still I still got to drive for a weekend. I didn’t think it would be much of an issue as I ‘ve been car-less almost half my adult life, i live a block from my work, and Columbia is a very bikable city.
I didn’t decide to do it until the night of September 30 so I couldn’t stock up on stuff ahead of time. Right off the bat I wanted to get some stuff for my Labor Day trip to Detroit but couldn’t rustle up the energy to ride my bike across town. I put it off once after a hard day at work, was rushed the night before and wanted to mow the lawn before leaving as well. I decided I’d stop by there on my way to pick up Trevor to go to the airport but it wasn’t open yet. Couldn’t lay hands on a 3 oz or less tube of toothpaste and so was forced to throw away a brand new 4 oz tube on the flight back. It really set the stage for the month with a lot more going without, a little bit more of doing things in a wasteful way, and very little actual bike riding.
On the way home from the airport on the final leg of the trip the truck crapped out on me on the highway and I had to leave it a foreign auto repair place in Wentzville and have Dad pick me up. That forced me to later go pick up the truck (the alternative of paying storage for a month seemed ridiculous so i considered it an extension of my original weekend allowed driving). We didn’t deduce what was wrong until me, the mechanic and the truck were all in the same place. Alternator brushes were shot leaving to come and go electrical problems. It was too late for him to fix it so i had to limp home hoping it would make it and driving through dusk with no headlights. it was all good and the mostly inoperable truck would be less of a temptation to drive.
The Challenge got me to break out my bicycle for the first time in 2010. It was good to ride and Sarah rode her bike over for our usual Farmers Market trip. It was fun to ride and we noticed we spent about twice as much time and were much more social because neither of us were eager to get back on our bikes to ride home. On the bad side I only bought about half as much stuff. No mum this year and I missed the last two weeks of sweet corn. All of my purchases were made with a lot more consideration for weight and volume since I only had what I could put in my backpack. I also wanted to get a lot of food because I couldn’t easily run by the store. I ended up only getting half as much as normal which was my first clue that not driving might not be an unmitigated good anymore.
I did some bike riding for fun rode to the market and the bank a couple of times. I was getting into it a bit but it was also making my back sore. One of my physical therapists had ID’d long distance bike riding of how I’d bulged my C-6 & 7 in my misspent youth when i was biking 150 miles a week. Mostly I skipped going to the store so there was less groceries. So we started walking to the Country Kitchen a lot and even resorted to eating at Bandanas.
Dad’s truck crapped out and still won’t start (hope its just batteries) so we were without a reliable vehicle. I couldn’t externalize my driving to the popster as I’d hoped he’d pick up the slack on the grocery shopping but instead stopped being able to do it all. I broke out the bike to go to the market and the tire was flat. So no farmers market at all. We needed stuff: food, ensure, booze. So I walked down to Mosers got a back pack and some bags worth and humped it all back. That was cool, nostalgic from when I was living in Berkeley and shopping by back pack.
I was bushed though and couldn’t muster up the energy to walk across town to get to Trevor and Lisa’s potluck. I decided to try to get my rewards card for the free flat tire fix rumored to be on it rather than walk down to Klunks. I also got to skip the bank by using the cash back option at the grocery store.
At this point a bit of a depression set in, short on stuff, dad rationing his ensures cuz he can’t drive and get more. fretting on him on how he’s going to get to walmart when his blood pressure pills run out. I tried to walk to the PedNet office to get my rewards card after the most difficult morning of my professional career but couldn’t make it down in time on my lunch hour and they close early. I got some taco bell instead and decided, fuck it, I’ll wait until i can drive.
I gutted it out but not with a lot of joy. Mostly I learned my truck is pretty decent. I get good mileage bundle my trips, don’t routinely drive and maybe put on 5K a year these days. I would’ve used it to go camping, build some trails in the Overland Bottoms, perhaps go to the EcoArt Fest down on the river. I would have bought three times as much market products in the month. I would have eaten out less and not at the soulless chains that are by my house. On the plus, it got me riding, it set an example, it focused me on my own locale. It showed me what driving means to me. Next year I expect to do it again.
sublime detroit part 1 – getting there
I am glad I took the extra day on the mini-vaca, it was nice to get ahead of the game instead of jumping right back into it tired and coming home beat down on my first day back. Things started out last friday way too early. i had lost my watch and didn’t own an alarm (i like to get up naturally instead of jarred awake at a set time [picked it up from O’ Henry]) so i slept poorly afraid of over sleeping. I got up, packed and drank almost the last of the coffee (sorry dad), tried to go to Wal-Mart for a couple of essentials but they weren’t open yet (i didn’t know they closed), went to Hi-V instead for amongst things a 3 oz or less toothpaste. Hi-V has about 14o square feet of toothpaste on display. All of it a variation on 4 brands none of them less than 4 oz. wtf. Hi-V customers don’t fly, or they know you’ll have to throw it away and buy another one. I hate that our society is organized that everyone is potentially planning to rip you off, makes me paranoid. I pass on the 2 oz training toothpaste because its fluoride free. I love fluoride, i’m 42 and still got all my teeth. I got the age defying brand for the liquid calcium. calcium carbonate has been shown to fill in microcavities, its worth the extra bit when you can find it. starbucks wasn’t open yet but trevor had coffee waiting. we drove to the airport like a couple of kids way early on christmas morning. we had been waiting and we were ready to have fun. the flight was pleasant, trevor let me have the window and i could see the exurban sprawl and farms sprawl and farms sprawl and farms across the midwest. we got a budget rental car, never have i turned down so many offers for the add on sale, extra insurance, nope, no deductible, nope, insurance rephrase, still nope, gps, nope (but now you don’t give me the map i was counting on, jerks), sattelite radio five dollar, nope, car upgrade nope, come on now not even one class for 5 dollars, nope. It got ritualistic and quick. I hate dehumanizing as a survival skill. Why do we set up the world where its peoples job to rip you off? Boom, off to Monroe. Flying is weird. I woke up in Missouri and I was having lunch in Monroe Michigan. Went to Pete’s Garage, but didn’t sit in a car. Both my sisters came and the one with the husband and kid brought there’s. It was nice to see everyone even though we’d just seen each other a month ago, still. We ate way too much bar food because we had already had coney island (gyro and fries, not the greatest but better than you can get in CoMo) at the airport. We drove up 275. I reminisced about riding the bike trail in its entirety when i was 19 (15o miles or so). I remembered riding with dad in the truck and him telling me about it and me saying some day i would ride it and i did, my last big ride before i bought my first car, when i seriously rode (when i likely bulged my 2 bulging discs). hardly any of its open now. they let it go to shit because they didn’t want to pay for the upkeep. looking back on it now that was the theme of the trip. decline, loss, frenetic remnants. then it was just appreciating the glory days. this makes me want to get a recumbent and really get back into riding. I am on the low car challenge this september, pledged to only one car trip this month which is completed. Tomorrow i’m forced to take my first bike ride of the season riding my bike to the bank, hopefully at lunch. I think I will pay myself a dollar a mile to ride my bike and put it towards a recumbent. that’d be fun and might work exercise back into my life. that’s part of what vacations are for me, to give me some space to step out of my life and see where it needs changing. Then though we were just driving and bullshitting. we pulled into farmington 15 minutes late. we saw jeff and becky and rosie leaving the bakery and followed them into the burger basement. nice place. the owner came out and said howdy, make your own combo on a check off sheet. I had 8 oz beef with jalapenos, olives, tomato, mixed greens, grilled pineapple, and swiss with barbecue sauce. nice. though mayo might have been better. It was great getting caught up with the burns-pavliks. rosie had turned into quite a prepossessed little 8 year old. she took us on the scenic way to their home in farmington hills and was quite the tour guide. She called us Uncle Mike and Uncle Trevor. I used to be Uncle Mike Trapp because she has a real Uncle Mike whose a bit of a character. I told her I was glad we were still fictional kin. Jeff picked up some first class local brews. Detroit Dwarf stands out as yummy and an interesting tale. Look it up its too late for me to regale you with it but its a tale worth telling. also had a smores beer, syrupy and over the top but a little glass was good. Both jeff and i dozed contentedly after we got caught up. It was one of those 20 hour days where you really suck the marrow out of your daily bone. I slept the sleep of the just. I was in Michigan. I was home.
black outs (notes)
Blackout (alcohol-related amnesia)
A blackout is a phenomenon caused by the intake of alcohol or other substance in which long term memory creation is impaired or there is a complete inability to recall the past. Blackouts are frequently described as having effects similar to that of anterograde amnesia, in which the subject cannot create memories after the event that caused amnesia. ‘Blacking out’ is not to be confused with the mutually exclusive act of ‘passing out‘, which means loss of consciousness. Research on alcohol blackouts was begun by E. M. Jellinek in the 1940s. Using data from a survey of Alcoholics Anonymous (AA) members, he came to believe that blackouts would be a good predictor of alcoholism.[1] However, there are conflicting views as to whether or not this is true.[2]
Alcohol and long-term memory
Various studies have also proven links between general alcohol consumption and its effects on memory creation.[3] Particularly, these studies have shown that associations made between words and objects when intoxicated are less easily recalled than associations made when not intoxicated. Later blackout-specific studies have indicated that alcohol specifically impairs the brain’s ability to take short-term memories and experiences and transfer them to long-term memory.[4]
It is a common misconception that blackouts generally occur only to alcoholics; research suggests that social drinkers, such as college students, are often at risk as well. In a 2002 survey of college students by researchers at Duke University Medical Center, 40% of those surveyed who had consumed alcohol recently reported having experienced a blackout within the preceding year.[5]
Types of blackouts
Blackouts can generally be divided into two categories, “en bloc” blackouts, and “fragmentary” blackouts. En bloc blackouts are classified by the inability to later recall any memories from the intoxicated period, even when prompted. These blackouts are characterized also by the ability to easily recall things that have occurred within the last 2 minutes, yet inability to recall anything prior to this period. As such, a person experiencing an en bloc blackout may not appear to be doing so, as they can carry on conversations or even manage to accomplish difficult feats. It is difficult to determine the end of this type of blackout as sleep typically occurs before they end.[6] Fragmentary blackouts are characterized by the ability to recall certain events from an intoxicated period, yet be unaware that other memories are missing until reminded of the existence of these ‘gaps’ in memory. This phenomenon is also termed a brownout. Research indicates that fragmentary blackouts, or brownouts are far more common than en bloc blackouts.[7]
Causes
Blackouts are commonly associated with the consumption of large amounts of alcohol; however, surveys of drinkers experiencing blackouts have indicated that they are not directly related to the amount of alcohol consumed. Respondents reported they frequently recalled having “drunk as much or more without memory loss”, compared to instances of blacking out.[6] Subsequent research has indicated that blackouts are most likely caused by a rapid increase in a person’s blood-alcohol concentration. One study, in particular, resulted in subjects being stratified easily into two groups, those who consumed alcohol very quickly, and blacked out, and those who did not black out by drinking alcohol slowly, despite being extremely intoxicated by the end of the study.[8]
Benzodiazepines
Benzodiazepines such as clonazepam (Klonopin), diazepam (Valium), and alprazolam (Xanax), which also act as GABA agonists, are known to cause blackouts as a result of high dose use.
Predisposition to blackouts
Research indicates that some users of alcohol, particularly those with a history of blackouts, are predisposed to experience blackouts more frequently than others.[9] One such study indicated a link between prenatal exposure to alcohol and vulnerability towards blackouts, in addition to the oft-cited link between this type of exposure and alcoholism.[10] Alternatively, another study has indicated that there appears to be a genetic predisposition towards blacking out, suggesting that some individuals are made to be susceptible to alcohol related amnesia.[11]
What Happened? Alcohol, Memory Blackouts, and the Brain
Aaron M. White, Ph.D.
Mechanisms underlying alcohol–induced memory impairments include disruption of activity in the hippocampus, a brain region that plays a central role in the formation of new auotbiographical memories.
In addition to impairing balance, motor coordination, decisionmaking, and a litany of other functions, alcohol produces detectable memory impairments beginning after just one or two drinks. As the dose increases, so does the magnitude of the memory impairments.
Early anecdotal evidence suggested that blackouts might actually reflect state–dependent information storage—that is, people might be able to remember events that occurred while they were intoxicated if they returned to that state. Regardless of how compelling such stories can be, clear evidence of state–dependent learning under the influence of alcohol is lacking. In one recent study, Weissenborn and Duka (2000) examined whether subjects who learned word lists while intoxicated could recall more items if they were intoxicated again during the testing session. No such state–dependency was observed. Similarly, Lisman (1974) tried unsuccessfully to help subjects resurrect lost information for events occurring during periods of intoxication by getting them intoxicated once again.
During the 2 weeks preceding the survey, an equal percentage of males and females experienced blackouts, despite the fact that males drank significantly more often and more heavily than females. This outcome suggests that at any given level of alcohol consumption, females—a group infrequently studied in the literature on blackouts—are at greater risk than males for experiencing blackouts. The greater tendency of females to black out likely arises, in part, from well–known gender differences in physiological factors that affect alcohol distribution and metabolism, such as body weight, proportion of body fat, and levels of key enzymes. There also is some evidence that females are more susceptible than males to milder forms of alcohol–induced memory impairments, even when given comparable doses of alcohol (Mumenthaler et al. 1999).
a recent study by Hartzler and Fromme (2003a) suggests that people with a history of blackouts are more vulnerable to the effects of alcohol on memory than those without a history of blackouts.
n an impressive longitudinal study, Baer and colleagues (2003) examined the drinking habits of pregnant women in 1974 and 1975, and then studied alcohol use and related problems in their offspring at seven different time points during the following 21 years. These authors observed that prenatal alcohol exposure was associated with increased rates of experiencing alcohol–related consequences, including blackouts, even after controlling for the offsprings’ general drinking habits.
Substantial evidence now indicates that alcohol selectively alters the activity of specific complexes of proteins embedded in the membranes of cells (i.e., receptors) that bind neurotransmitters such as gamma–aminobutyric acid (GABA), glutamate, serotonin, acetylcholine, and glycine (for a review, see Little 1999)
More than 30 years ago, both Ryback (1970) and Goodwin and colleagues (1969a) speculated that alcohol might impair memory formation by disrupting activity in the hippocampus. This speculation was based on the observation that acute alcohol exposure (in humans) produces a syndrome of memory impairments similar in many ways to the impairments produced by hippocampal damage. Specifically, both acute alcohol exposure and hippocampal damage impair the ability to form new long–term, explicit memories but do not affect short–term memory storage or, in general, the recall of information from long–term storage.
Research conducted in the past few decades using animal models supports the hypothesis that alcohol impairs memory formation, at least in part, by disrupting activity in the hippocampus (for a review, see White et al. 2000b). Such research has included behavioral observation; examination of slices of and brain tissue, neurons in cell culture, and brain activity in anesthetized or freely behaving animals; and a variety of pharmacological techniques.
depression notes
notes for my education group on depression for outpatient substance abuse treatment program. info pulled from WebMD who pulled heavily from the DSM. First off is criteria:
- difficulty concentrating, remembering details, and making decisions
- fatigue and decreased energy
- feelings of guilt, worthlessness, and/or helplessness
- feelings of hopelessness and/or pessimism
- insomnia, early-morning wakefulness, or excessive sleeping
- irritability, restlessness
- loss of interest in activities or hobbies once pleasurable, including sex
- overeating or appetite loss
- persistent aches or pains, headaches, cramps, or digestive problems that do not ease even with treatment
- persistent sad, anxious, or “empty” feelings
- thoughts of suicide, suicide attempts
major depression
To distinguish major depression, one of the symptoms must be either depressed mood or loss of interest. Also, the symptoms must be present for most of the day every day or nearly every day for at least two weeks.
Major depression affects about 6.7% of the U.S. population over age 18, according to the National Institute of Mental Health. Overall, between 20% and 25% may suffer an episode of major depression at some point during their lifetime.
Dysthymia
According to the National Institute of Mental Health, approximately 10.9 million Americans aged 18 and older are affected by dysthymia. While not disabling like major depression, dysthymia can keep you from feeling your best and functioning optimally. Dysthymia can begin in childhood or in adulthood and seems to be more common in women.
ATYPICAL DEPRESSION is probably rather common. Some doctors believe that it is underdiagnosed. Researchers are considering whether or not atypical depression might be a type of dysthymia — a low-level depression that has lingered for at least two years. Researchers are also investigating the idea that atypical depression may be a milder form of bipolar disorder called cyclothymia. People with cyclothymia typically have less extreme switches in mood.
What are the symptoms of atypical depression?
The main characteristic of atypical depression that distinguishes it from major depression is mood reactivity. In other words, the person with atypical depression will see his or her mood improve if something positive happens. In major, or melancholic, depression, positive changes will not bring on a change in mood. In addition, diagnostic criteria call for at least two of the following symptoms to accompany the mood reactivity:
- sleeping too much (hypersomnia)
- eating too much (hyperphagia), resulting in weight gain
- having a more intense reaction or increased sensitivity to rejection, resulting in problems with social and work relationships
- having a feeling of being weighed down, paralyzed, or “leaden”
Not to leave anyone without solutions i am a huge proponent of reframing for depression. I have bi-polar disorder and reframing allows me to function if not normally, at least largely functioning. It is the idea that perspective makes the picture and you can change how situations impact you by changing how you think about them. For me the what would normally be a depressed state I reframe as flat. It means i don’t have a lot of energy or motivation but I have removed the negative thinking that typically runs with a down mood. So its no longer depression, just a flat time. I cut myself a little slack on not getting things done, meet my major commitments and what could be a disabling condition gets reframed into at most an annoyance at best just something that makes me me. Add to that sunlight and exercise. Its simple but not easy. Make hay when the sun is shining, don’t forget its going to get better, just hang in there.
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