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Concurrent Disorders – Overcoming a Dual Diagnosis with the Help of Hope Rehab Thailand

by Hope Rehab Team

Topic at a glance:
  • A concurrent disorder (aka dual diagnosis) refers to the combination of a mental health issue with a substance abuse problem.
  • Drug abuse can cause, worsen, or trigger a mental health problem.
  • The failure to properly treat a concurrent disorder is a common reason for people in early recovery from addiction to relapse.
  • The mental health issues that are most likely to coexist with an addiction problem are depression, anxiety disorders, and personality disorders.

The term concurrent disorders –formerly called dual diagnosis, or in layman’s terms ‘double trouble’- refers to the combination of mental health and substance misuse issues. Examples of concurrent disorders include PTSD or clinical depression and alcohol addiction, ADHD and cocaine addiction, or Generalized Anxiety Disorder and Benzodiazepine dependency.

How frequently do mental health issues coexist with substance misuse?

While there are variations as to the degree that substance abuse and mental health disorders coexist depending on the mental health diagnosis or type of substance abuse someone is struggling with, the general rule is that it is more likely than not that both are present at the same time.

What is the link between Mental Health and Substance Use problems?

The link between mental health and substance use problems is manifold:

  • A family history of either mental illness or substance abuse may translate into genetic vulnerability and susceptibility to alcohol and drug use, and/or mental health problems.

  • Research indicates that adverse childhood events, such as child sexual/physical/emotional abuse may predispose individuals to mental health and/or substance use problems in adulthood.

  • Prolonged or extensive substance abuse may cause, exacerbate, mimic or mask mental health symptoms. Mental health problems caused by substance abuse typically resolve once sobriety is achieved, although vulnerability for mental health problems may persist.

  • Substances can compound or exacerbate mental health symptoms. For example, alcohol is a central nervous depressant, thus slowing down or sedating nervous system functioning and therefore worsening already existing symptoms of depression such as hypersomnia or lack of motivation.

  • Substance use tends to cause instability in regards to mood, physical energy, sleep, mental functioning, motivation etc, all areas also impacted by mental health issues. As such, it is not uncommon for substance users to have inaccurate mental health diagnosis, most commonly a diagnosis of bipolar disorder.

  • Some symptoms are common to both mental health and substance misuse, such as insomnia, or problems focusing or concentrating. It is therefore often difficult to ascertain whether reported symptoms stem from substance abuse, or are instead a reflection of mental health difficulties.

  • Mental health issues are known to increase the brain’s vulnerability to harmful effects of drugs, as posited in the super sensitivity model. This model simply suggests that the brains of individuals suffering from a mental illness are more strongly and more negatively impacted by even minor amounts of alcohol and drugs as compared to individuals free from mental health problems.

  • Alcohol or drug dependency make it more difficult to recover from a mental illness such as depression or anxiety, as it interferes with an individual’s commitment and adherence to treatment (including attending medical or counselling appointments or taking prescribed medications), and because it impacts their ability to learn coping skills helpful in countering mental health symptoms.

  • Mental health problems typically interfere with an individual’s day to day functioning as it pertains to work, relationships, general productivity and leisure, often causing significant problems in these areas of functioning. The longer these difficulties persist, the more likely individuals are to seek some sort of escape or relief by consuming alcohol or substances.

  • A relapse of mental health symptoms may provoke a relapse into substance use, and vice versa.

It is therefore important to understand that Mental health and substance problems interact with one another in multiple and complex ways, and these interactions changes both the course and the outcome of the problems individuals experience. In short, it’s complicated!

Why is it Important to Know about Concurrent Disorders?

Compared to an individual suffering from either an addiction OR a mental illness alone, individuals suffering from concurrent disorders are more likely to:

  • Experience more significant problems in major areas of functioning, including work, relationships, productivity and leisure.

  • Have difficulties with maintaining housing, employment and the law.
  • Require prolonged and skilled treatment, including a recovery plan that takes into account that relapse of mental health symptoms will likely trigger relapse into addictive behaviours, and vice versa.

How are Concurrent Disorders assessed?

Given the complexity and multiple ways in which mental health and substance use problems interact, an assessment of such problems requires skill and time and it is rarely complete or accurate if completed in one short session. Not surprisingly, individuals are often misdiagnosed and therefore at risk for receiving inadequate, unnecessary or insufficient treatment for their problems.

A comprehensive assessment by a skilled clinician trained in the areas of mental health and substance use is therefore highly recommended. At Hope Rehab Center, we provide skilled care through our multidisciplinary team, and we often work in collaboration with clients’ physicians in order to guarantee best possible treatment outcomes for our residents.

Depression

Depression is one of the most common mental health concerns of modern times. While depression rates are high for substance users and non-users alike, the lifetime prevalence of depression for substance users is approximately 24% higher than in the general population. Worldwide, depression has risen to unprecedented proportions and the World Health Organization now predicts epidemic levels of depression by the year 2020. In clinical terms, depression is sometimes referred to as Depressive Disorders or Mood Disorders.

What is Depression?

Many people use the term depression to describe sad mood or feeling ‘blue’. This, however, is far from the experience of clinical depression which can take on different forms, including:

  • Profound lack of energy.

  • Changes in eating and sleeping patterns.

  • Difficulties in all areas of cognitive functioning.

  • A significant loss in previous interests or loss of ability to experience pleasure.

  • Intrusive thoughts of suicide.

  • Persistent feelings of worthlessness and guilt.

  • Depressed mood most of the time .

These symptoms are so severe that they greatly impact individuals’ ability to work or study, and/or be able to maintain meaningful relationships. If the symptoms last more than two weeks, it is considered a major depressive episode.

Persistent Depressive Disorder (Dysthymia)

This is considered a milder form of depression, with some of the same symptoms as described above, but lasting for at least 2 years. Individuals experiencing dysthymia have a tendency to look at the glass half empty, and typically cannot recall a time in their lives when they have ever been truly happy or even content. In the past, this type of depression was referred to as Depressive Personality Disorder.

Bipolar Illness (formerly called manic depressive illness)

Individuals experience extremes in mood, alternating between periods of extreme depression and mania. The hallmark of the latter are excessive energy and a decreased need for sleep, typically accompanied by a sense of grandiosity and high risk behaviours such as drug use, promiscuity or gambling.

Unlike major depressive illness which may be recurrent but is very much treatable, bipolar illness is chronic in nature and requires skilled intervention that includes medication. Not surprisingly, Bipolar illness is the most frequently misdiagnosed mental illness in the context of substance use, given that the ups and downs in moods caused by substance use can easily be mistaken as depression and mania to the untrained eye. Bipolar illness can take on various forms such as bipolar I or II, rapid cycling bipolar, all of which causing individuals difficulties in functioning to at least some degree.

How is depression linked to substance use?

In the context of substance use and recovery from addiction, depression can show up in various ways, including but not limited to:

  • A depressed mood is a common consequence of coming down from a substance induced ‘high’. For example, stimulant users often report experiencing depressed mood, profound lack of energy and disabling physical fatigue at the tail end of heavy use, during withdrawal and early abstinence.

  • Individuals suffering from depression may use alcohol or other substances to cope with difficult symptoms, especially when these become chronic. For example, research shows that depression precedes methamphetamine use.

  • Post-acute withdrawal symptoms are similar to symptoms of depression, including decreased motivation, lack of physical energy, difficulties concentrating and insomnia.

  • The overlap of bipolar illness and substance abuse is 60%.

  • Individuals suffering from depression are twice as likely to develop substance abuse problems as compared to the general population.

  • Marijuana use is shown to impact cognitive abilities and motivation, and chronic use may cause depression in some individuals.

  • Depression is common in illicit opiate users and symptom severity increases with heavier substance use; symptoms typically improve or subside during treatment.

  • Alcohol is a central nervous depressant, and chronic alcohol misuse been shown to cause symptoms of depression.

How is Depression Treated?

Drug induced symptoms of depression often clear with prolonged abstinence and may not need any specialized treatment. Additionally, many therapeutic interventions helpful for the treatment of addiction are equally helpful in the treatment of depression, such as cognitive behavioural therapy (CBT). If symptoms persist, treatment is readily available and the choice of treatment strongly depends on type, severity and chronicity of symptoms, as well as individual preferences. For example, mild to moderate depression can be treated with short-term cognitive behavioural therapy (CBT) and changes in lifestyle. This type of treatment includes a focus on challenging and changing negative thoughts, setting small behavioural goals to achieve healthy routines as they pertain to physical exercise, diet and sleep.

Severe depression and Persistent Depressive Disorders on the other hand typically require a combination antidepressant medication and psychotherapy for best and lasting results. Bipolar disorder I is one of the most debilitating mental health disorders and typically requires long-term and multi-faceted interventions that include medication, community support and specialized forms of therapy, such as Interpersonal and Social Rhythm Therapy.

How is Depression Treated?

Drug induced symptoms of depression often clear with prolonged abstinence and may not need any specialized treatment. Additionally, many therapeutic interventions helpful for the treatment of addiction are equally helpful in the treatment of depression, such as cognitive behavioural therapy (CBT). If symptoms persist, treatment is readily available and the choice of treatment strongly depends on type, severity and chronicity of symptoms, as well as individual preferences. For example, mild to moderate depression can be treated with short-term cognitive behavioural therapy (CBT) and changes in lifestyle. This type of treatment includes a focus on challenging and changing negative thoughts, setting small behavioural goals to achieve healthy routines as they pertain to physical exercise, diet and sleep.

Severe depression and Persistent Depressive Disorders on the other hand typically require a combination antidepressant medication and psychotherapy for best and lasting results. Bipolar disorder I is one of the most debilitating mental health disorders and typically requires long-term and multi-faceted interventions that include medication, community support and specialized forms of therapy, such as Interpersonal and Social Rhythm Therapy.

What Hope Offers for those Suffering from Depression

Hope Rehab Thailand draws on multiple therapeutic interventions helpful in addressing not only the symptoms of depression, but also contributory and causal factors. These interventions include:

  • Cognitive Behavioural Therapy (CBT): Hope Rehab Center offers weekly CBT group therapy sessions to help residents to identify, challenge and change negative thoughts that typically contribute to, and maintain a depressed mood.

  • Individual Counselling Sessions: Every resident has two weekly individual counselling sessions to address issues specific to the individual, such as blocks to creating a healthy anti-depression lifestyle, negative Core Beliefs or interpersonal issues.

  • Mindfulness & Mediation: At Hope Rehab, we offer daily guided meditation practice, as well as weekly individual and group mindfulness sessions. These practices can be helpful to individuals suffering from depression as they learn to disengage from negative thoughts, tolerate difficult emotions and intentionally direct their focus on positives rather than negatives.

  • Daily Gratitude Circle: Learning to focus on what we have, on what is working, on what we do well is a helpful tool in countering depression’s focus on personal failures and shortcomings, and on the proverbial  ‘the glass half empty philosophy’.

  • Yoga: Research shows that a regular yoga practice supports individuals’ journey towards improved physical, emotional and mental health and spiritual healing. At Hope Rehab Center, we offer various styles of yoga to ensure everyone can participate in, and harvest yoga’s vast benefits. Types of yoga offered include flow yoga, hot stone meditation and yoga or restorative yoga.

  • Healthy Lifestyle: At Hope Rehab, we emphasize a healthy lifestyle, which includes daily physical exercise, healthy nutritious meals, solid routines around bedtime, mandatory therapy sessions, and a strong community focus to enhance social and emotional health.

  • Afternoon Activities & Weekly Excursions: Following our mandatory morning program, residents are encouraged to participate in daily afternoon activities and organized weekend outings. Getting actively involved in social and other life enhancing activities is particularly important for those suffering from depression, as social isolation and a loss of interest in mood enhancing activities are very common symptoms of depression.

  • Recovery Meetings: Hope Rehab Center offers addictions focused recovery meetings three times weekly, each with a slightly different focus. This allows attendees to connect with others through sharing of individual struggles and stories of survival pertaining to addictions and mental health recovery. For individuals suffering from depression who typically isolate, learning they are not alone with their difficulties is a wonderful invitation to belong and participate in community again.

Anxiety

Next to depression, anxiety is the most frequently diagnosed mental health concerns of our time, and substance users are 20-40% more likely to experience anxiety disorders as compared to the general population. Conversely, individuals diagnosed with any Anxiety Disorders are at higher risk of developing addictive behaviors, and Generalized Anxiety Disorder was most frequently associated with alcohol and drug problems. Anxiety is also often experienced by those suffering from depression.

What is Anxiety?

Everyone experiences anxiety sometimes; anxiety is closely related to the stress response in our body, which alarms us to any potential danger and is thus crucial for our survival. This automatic fight, flight or freeze response to danger can be noticed as tightness in the chest, an accelerated heartbeat, gastrointestinal problems, racing thoughts about impeding catastrophies or constant worrying, and difficulties thinking clearly.

If Everyone Experiences Anxiety, Why is it a Problem?

Our stress response can be seen like a smoke alarm: it is very helpful when real danger exists, such as a fire. It is not so helpful when this alarm system goes off indiscriminately, constantly and for no good reason. For individuals suffering from General Anxiety Disorder (GAD), this is the case: they constantly worry about potential and disastrous ‘what ifs’ of the future, they experience chronic bodily symptoms such as angina or Irritable Bowel Syndrome (IBS), and they feel tense and unable to relax or sleep. Among the various forms of anxiety disorders, GAD is the one most often experienced by substance users.

How Do I Know that My Levels of Anxiety are Beyond What is Considered ‘Normal’?

We all experience anxiety sometimes; no doubt about that. It is very normal, for example, to experience anxiety when going for a job interview or entering rehab for the first time; in short, when we face uncertainty and when circumstances and events are outside of our control. While most of us manage these short-lived anxiety provoking situations without lasting problems, individuals suffering from anxiety disorders may feel so stressed and become so worried about all the potential ‘what ifs’ of the situation that they feel unable to cope, and they are thus inclined to avoid and withdraw. This typically starts in one area of one’s life, for example when we are socially anxious we may avoid invitations to social events.

Over time, anxiety silently slithers into other areas of our life, making us believe we don’t have what it takes to meet the challenge at hand. Eventually, if we let it, anxiety tends to shrink our life to the point where we are afraid to face any challenge at all, no matter how minor. In short, if anxiety interferes with day to day functioning as it pertains to social relationships, works or leisure, or if it renders us unable live life fully, then it is time to seek..

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Behavioral Addiction in Women – The Neglected Cousin of Alcohol and Drug Addiction

by Hope Rehab Team

Topic at a glance:
  • Behavioral addiction describes problematic behaviors over which an individual has no longer control.
  • There are significant similarities between substance use disorders and behavioral addictions.
  • Women are actually the front runners in behavioral addictions such as food addiction, compulsive shopping or plastic surgery.
  • Individualized care-planning, cognitive-behavioral therapy, mindfulness, and mind-body therapies can be effective at helping women escape behavioral addictions.
Behavioral Addiction in Women Not Taken Seriously Enough

The topic is perhaps one of the most controversial in contemporary addictions research, and the jury is still out: are compulsive behaviors similar to substance dependencies in cause, course and impact, or are they problematic misconduct at best?

With the exception of compulsive gambling, none of the so called addictive behaviors managed to claim its place as an equal next to other recognized Substance Use Disorders in the most recent edition of the DSM (Diagnostical Statistical Manual V), the widely used mental health bible issued by the American Psychiatric Association (APA). Perhaps due to this lack of clinical recognition, behavioral addictions are often overlooked or not taken seriously enough. This notwithstanding, the impact on individuals afflicted by such compulsive behaviors and their loved ones can be grave.

Unlike alcohol and illegal drug use that affects men disproportionately among the genders, women are actually the front runners in compulsive behavior problems such as food addiction, compulsive shopping or plastic surgery. Contrary to popular belief, women are also not far behind their male counterparts when it comes to hypersexuality, or problematic internet use or gambling.

Apples or Oranges: Compulsive Behaviors versus Chemical Dependencies

Behavioral addiction describes problematic behaviors over which an individual has no longer control. Similar to individuals addicted to substances, such persons are mentally consumed with the problematic activity; if they are not engaging in it, they are thinking about it, or crave it. Extensive amount of time is spent to pursue, engage in or recovering from the addictive behavior, often at the expense of daily familial or work-related duties. Those afflicted report a feeling of tension or anticipatory excitement in preparation of the activity and pleasure or relief of tension as result of engaging in the acitivity. Also similar to alcohol and drug addicts, they are unable to stop themselves despite growing negative consequences, thus reflecting a severe loss of control.

Somewhat surprising perhaps is the fact that behavioral addiction also results into tolerance and withdrawal. Individuals have to increase or somehow intensify the behavior in order to continue achieving the desired effect, just as drug addicts have to increase their dosage, or change the mix of drugs they are taking to get high over time. Although withdrawal symptoms are less physical compared to those experienced following the cessation of alcohol and many of the illegal drugs, marked irritability, anger, anxiety, problems with cognitive functioning and sleep have been observed.

Women are actually the front runners in compulsive behavior problems such as food addiction, compulsive shopping or plastic surgery. 

 

In short, while much more research is necessary, including those leading to clear diagnostic criterias, existing studies have shown significant similarities between substance use disorders and behavioral addictions. Interestingly, and although impulsivity control problems are part of the picture for both substance use disorders and behavioral addictions, researchers distinguish these from pure impulse control disorders such as kleptomania, pathological skin picking or firesetting. The latter are in fact seen as more similar to conduct disorders rather than addictive disorders.

Gender differences: general trends

Telescoping, the fact that addiction to alcohol and drugs tends to develop quicker in women as compared to men, also appears to be true for behavioral addictions. Apart from this, research as to how behavioral addiction affects women differently from men is still in its infancy. What is known is that women show higher rates in compulsive shopping and food binging, while men are more prone to fall victim to compulsive exercising, gambling and hypersexuality. Some of these behaviors also appear to show differences in patterns of activities. For example, for compulsive gambling, men are more likely to get involved with internet gambling, betting, casino tables or poker. Female compulsive gamblers on the other hand show more affinity to “ scratch and win“ games. Although pathological gambling appears to affect much more men than women, those women are affected by it tend to show higher rates of suicidality.

Women are also more prone to develop problematic eating patterns, including higher levels of addiction to chocolate (yes, sorry, it does exist!). Hormonal fluctuations may play a role here, as cravings for sweets and chocolates are reportedly highest among women during premenstrual phases. Although men are typically more prone to hypersexual behaviors than women, one study found that approximately 7% of interviewed women in the US report sexual fantasies, urges, or behaviors they considered out of control. While young males are most likely to engage in excessive video game or other computer activities, young women have been found to be more vulnerable to spending extensive time on social media. Small to no gender differences are found in compulsive exercising.

Areas of Female Dominance: A Closer Look

Women account disproportionally for those affected by problematic eating patterns, plastic surgery and compulsive shopping. Two of these are particularly controversial as it relates to comparisons to substance use disorders:

Plastic Surgery

Let’s start with the least well understood and perhaps most surprising among compulsive behaviors: plastic surgery. Research findings suggest that women almost exclusively account for those repeatedly, voluntarily, excessively and without sound medical rationale undergoing surgical procedures. Among the 1.8 million surgical procedures done in the US in 2017, the top five are those commonly sought after by women: breast augmentation, liposuction, nose corrections, tummy tucks and eyelid lid surgery. Called minimally invasive procedures, things like botox injections, soft tissue fillers and laser hair removals are also mostly done by women. $16.4 billion US dollars worth, 92% of patients are Caucasian women in their forties and fifties.

Such cosmetic and medically unfounded procedures may not constitute a problem behavior per se, but can become problematic if resulting into negative consequences for the patient, or her loved ones. Studies suggest that patient expectations play a significant role as to whether surgical procedures will enhance or diminish life. Unrealistic expectations, such as hoping that younger looks will save a relationship, or solve some other identified problem in a patient’s life, are likely to result into grave disappointment, or even depression. A recent study has found a disturbing link between breast augmentation surgery and increased suicide rates among patients who voluntarily submitted to this procedure. Allergic reactions, infections, nerve damage, financial problems, or botched facial or bodily features followed by social alienation are other potential negative consequences women may experience.

Research findings suggest that women almost exclusively account for those repeatedly, voluntarily, excessively and without sound medical rationale undergoing surgical procedures.

 

Research into this rather puzzling compulsive behaviour among women has also found a strong link to mental health problems. Depression, substance use disorders, social anxiety, eating disorders, obsessive compulsive disorders and personality disorders are all found in women repeatedly undergoing the knife to change some perceived imperfection. Not surprisingly, Body Dismorphic Disorder (a firmly held and distorted belief about one’s perceived body image) is also implicated, making it likely that whatever the result, it will never suffice. Like a drug addict always wanting more and different but never having enough, these women find some part of their body that in their mind does not measure up.

Gender Stereotypes and Plastic Surgery

Quite obviously, gender stereotypes play a role in this. Women who are neither slim nor young are treated differently than those who fit the culturally prescribed ideal, affecting especially younger women’s self esteem negatively. Problems with relationships may be particularly attributed to looks, translating into aforementioned unrealistic expectations, and false hopes. Root causes may go deeper still.

Clinicians and researchers in the field of trauma suggest trauma may play a role. Navajits, for example, posits that behaviors such as compulsive cosmetic surgery, excessive tanning or tattoing may all be similar to self-injurious behaviors such as cutting. Often accompanied by anticipatory excitement and temporary relief of tension while engaging in these activities, these behaviors may pose trauma reenactment. Trauma survivors may engage in behaviors that evoke similar emotional states as the original emotional trauma in order to gain control over this devastating experience.

This theory seems supported by the fact that female teens who undergo cosmetic surgery are more likely to show a history of self injurious behaviors, such as cutting or burning themselves. They also tend to suffer from anxiety and depression, which is often aggravated rather than alleviated as a consequence oft he chosen procedure. Interesting, this theory has also been implicated in the cause of hypersexual behaviors in women, as female survivors of child sexual abuse, specifically those exposed to pornography early in life, are said to be particularly at risk for developing this type of behavior.

Compulsive Overeating Or Binge Eating

Compulsive overeating, binge eating, food addiction and disordered eating are terms that are often used interchangeably, and medical professionals appear to differ as to whether or not these different terms do or do not constitute the same thing. Fact is, the American Psychiatric Association (APA) has included Binge Eating Disorder (BED) for the first time in the last edition of the Diagnostic Statistical Manual (DSM V), thus suggesting it to be equal to, yet different from other recognized eating disorders such as Bulimia Nervosa or Anorexia.

Although it remains highly controversial to compare eating disorders with addictive disorders, commonalities exist in some aspects. For example, BED sufferers report a loss of control over their behavior despite of increasing negative consequences, the most visible one being obesity. Following initial short-lived relief of tension or anxiety, shame, guilt and disgust with self after gorging large amounts of foods are also part of sufferers’ common experience. Eating alone in an attempt to hide or lie about how much they are actually consuming is common, the same way that hiding and lying about substance or alcohol use is part of addictions.

Women and Problematic Eating

Two thirds of individuals suffering from this type of problematic eating are women, and many are obese. There are no attempts to counter the massive caloric intake by purging or through laxatives as common in Bulimia. Health consequences can be severe, and include:

  • Heart problems.

  • High blood pressure.

  • Sleep apnea.

  • Diabetes and insulin resistance.

Although BED affects women across race and age, in the US, African American women have been particularly implicated. Poverty is a suspect in exploring external risk factors, taking into consideration that food with low nutritious content, thus processed food high in sugar, salt and fat, is typically cheaper. Marketing of low nutritious foods and beverages occurs to a much greater rate in low socioeconomic neighborhoods compared to White areas, also accounting for increased purchasing of such foods by those living in poverty.

Binge Eating as an Addiction

These unhealthy foods are said to have increased addictive qualities, affecting dopamine regulated brain reward pathways, resulting into increasing cravings for more of the same. Research has shown that those suffering from BED in fact show the same reaction to food cues as alcoholics show to cues involving drinking cues.  These common neurobiological underpinnings may be account for the fact that severe binging has been linked to increased alcohol consumption. Research also showed similarities in personality traits, such a need for control, between individuals suffering from eating disorders, and those struggling with alcohol and drug addiction, disregarding what subtype of eating disorder is involved.

Often cited as a potential precursor to BED, emotional overeating may initially start a response to stressful or overwhelming feelings. Dissatisfaction with body image and anxiety related to ones’ appearance in general have also all been linked to overeating. Women with BED also tend to show elevated rates of depression, substance use and personality disorders compared to women not engaging in disordered eating.

Although BED affects women across race and age, in the US, African American women have been particularly implicated. Poverty is a suspect in exploring external risk factors, taking into consideration that food with low nutritious content, thus processed food high in sugar, salt and fat, is typically cheaper. Marketing of low nutritious foods and beverages occurs to a much greater rate in low socioeconomic neighborhoods compared to White areas, also accounting for increased purchasing of such foods by those living in poverty.

Binge Eating as an Addiction

These unhealthy foods are said to have increased addictive qualities, affecting dopamine regulated brain reward pathways, resulting into increasing cravings for more of the same. Research has shown that those suffering from BED in fact show the same reaction to food cues as alcoholics show to cues involving drinking cues.  These common neurobiological underpinnings may be account for the fact that severe binging has been linked to increased alcohol consumption. Research also showed similarities in personality traits, such a need for control, between individuals suffering from eating disorders, and those struggling with alcohol and drug addiction, disregarding what subtype of eating disorder is involved.

Often cited as a potential precursor to BED, emotional overeating may initially start a response to stressful or overwhelming feelings. Dissatisfaction with body image and anxiety related to ones’ appearance in general have also all been linked to overeating. Women with BED also tend to show elevated rates of depression, substance use and personality disorders compared to women not engaging in disordered eating.

From Passion to Compulsion: Tell-Tale Signs You’ve Crossed the Line

As with alcohol or drug addiction, there are clear signs to indicate a behavior has become more than just passion or pastime.

  • The individual spends increasing amounts of time engaging in the activity.

  • Former hobbies may be left behind, and relationships neglected.

  • Marital problems, familial discord and declining work productivity may ensue as a consequence.

  • Attempts to address concerns around the behavior will likely evoke strong defensiveness, followed by a creative list of never-ending excuses.

  • Lying or hiding how much time is being spent is also part of the picture.

  • Overspending, maxed out credit cards, and financial problems in general may be indicators of compulsive shopping.

  • Extended hours spent at the gym or at work may indicate the need to exercise excessively, or workaholism.

  • Continuously exercising or working in spite of ill health can also be reason for concern.

For some addictive behaviors, such as compulsive eating or hypersexuality, physical signs may be present. For example, weight gain or obesity may be evidence of binge eating behaviors. If binging is accompanied by purging, the afflicted person may show dental problems or signs of nutritional deficiencies, perhaps seeking professional help around these issues. Hypersexuality puts women at risk for STDs and violence, and signs can include anything from repeated doctor or pharmacy visits, to unexplained injuries. Using the internet in secrecy may also be a sign of cybersex or gambling activities.

If You Can’t Stop, You Have a Problem

As with any form of addiction, a clear indicator as to whether or not something constitutes a problem is repeated unsuccessful attempts to curtail time spent engaging in the activity. Just as alcohol or drug addicted individuals, those struggling with behavioral addiction are typically unable to shorten the time engaging in the problematic behavior. Moreover, attempts to do so may provoke withdrawal symptoms such as strong irritability, increased anxiety, mood swings or aggressive behaviors towards those getting in the way of pursuing renewed engagement with the problematic activity.

Clinically, in order to be considered problematic or compulsive in nature, individuals must show some degree of inability to function at home or at work as a result of their behavior.

Help & Support: What Loved Ones Can Do

Research findings indicate that persons with behavioral addictions do not tend to reach out for help, or for professional treatment. They do however sometimes reach out for help in dealing with the consequences of their addiction. For example, obese individuals may approach their doctors in getting help with their weight problem, and compulsive shoppers or gamblers may approach their family members for financial help. Women engaging in hypersexual behavior may seek medical attention for STD’s. Affected individuals may be asked to seek EAP (Employee Assistance Programs) services following decline in workplace productivity. Although regulations binding professionals to confidentiality, family member can offer rather than seeking information to professionals involved with their loved one. This will provide context and background to a patient’s presentation, and subsequent appointments may potentially fruitful conversation as to what is really going on.

Compulsive gamblers, shoppers, overeaters are not likely to share loved ones’ concerns. For them, the activity is one that provides relief and is thus more a solution, however temporary, rather than a problem. As such, nagging, complaining and pleading are not likely to produce desired behavior changes. The following suggestions may prove more helpful:

  • As with all forms of addiction, address your concerns openly with our loved one. Failure to address concerns directly, or denying, turning a blind eye..

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Group Therapy for Addicts: Natural Antidote to Despair

by Hope Rehab Team

Topic at a glance:
  • Allowing ourselves to be vulnerable in group therapy means we get to see that we are not alone in our difficulties. It helps us connect.
  • Group therapy helps us to see that expressing our emotions is not only acceptable but also necessary for our mental health.
  • Group therapy can act as a microcosm of the outside world where we get to practice communication tools and explore unhelpful coping strategies in a safe space.
  • Group therapy can sometimes be an impropriate intervention for those of us with severe personality disorders, social anxiety, or a history of trauma.
Group Therapy is Often Misunderstood

Jack Nicholson really did it! As Randy in the Hollywood block-buster “One Flew Over the Cuckoo’s Nest” he must have turned a whole generation of movie viewers off and away from group therapy. Domineering, belligerent, rebelling and at times aggressive during group sessions, neither he nor others benefit.

The movie won producers and Nicholson more than one Oscar, and left viewers with the unfortunate impression that group therapy is an emotionally unsafe process, in part orchestrated by group leaders that seem to have more issues than the patients. While most of us understand this is a rather unrealistic depiction of what actually takes place in group therapy today, lingering images and uncertainties may get in the way with seeking and experiencing the transformative and often life changing power group therapy really holds.

How strange that we should ordinarily feel compelled to hide our wounds when we are all wounded! Community requires the ability to expose our wounds and the weaknesses to our fellow creatures. It also requires the ability to be affected by the wounds of others… But even more important is the love that arises among us when we share, both ways, our woundedness.”

M Scott Peck

The Real Thing: What Happens in Group Therapy

At first glance, getting patients struggling with identical or at least similar problems together in groups seems a matter of logic, cost efficiency and practicality. Widely used in a multitude of health care settings, people are brought together to learn together about causes, course and coping strategies. Group sessions are typically available on an in- or outpatient basis.

In outpatient programs, group sessions are typically held once weekly for up to two hours over the course of 12-16 weeks, while inpatient, intensive or residential programs offer daily sessions in a shorter time frame. For example, residential alcohol or drug centers tend to offer treatment for a minimum of 30 days, often with the option to extent. A residential or inpatient program immersion allows patients to relinquish the responsibilities and distractions of everyday life, thereby allowing them to fully concentrate on the changes they wish to make.

Skills & Tools

During initial sessions in an addictions group, participants may learn about the cause and course of addiction, and the ups and downs of their recovery. Common topics can include stages of change, the nature of post-acute withdrawal or key factors in long-term recovery. Psycho-educational sessions may also teach group members about issues underlying or feeding an addiction, such as mental health issues or long-term stress.

As sessions progress, members are invited to learn skills and strategies necessary to support changes in unhelpful behavior. For example, cognitive-behavioral therapy (CBT), one of the most frequently utilized approaches in the treatment of addiction, focuses on identifying, challenging and changing negative thoughts as these typically translate into unhelpful behavior. Behavioral or emotional focused skills may aim at improving one’s ability to resist peer pressure, or observe rather than to act on urges to use or conquer high-risk situations.

Digging Deeper – Where the Healing Begins

Sharing with others is a crucial aspect for addictions or mental health group therapy, as struggling with addiction and/or mental health problems typically entails a range of difficult emotions, thoughts and behavior that are often not well understood by family or friends. Sometimes, divulging such difficult internal experiences can be outright scary for loved ones, as in the case with suicidal thoughts, urges to self-harm or cravings to use just after an overdose.

Group participants often voice an incredible sense of relief understanding that they are not alone with what is perhaps considered unacceptable or crazy, or what is frightening for themselves or others around them. There is instant and strong connection when we hear another human being express the same doubts, questions, dark thoughts, confusing emotions that have tormented us for months, sometimes years. Allowing ourselves to be vulnerable in this way, we learn very quickly that we are not alone in our difficulties.

A residential or inpatient program immersion allows patients to relinquish the responsibilities and distractions of everyday life, thereby allowing them to fully concentrate on the changes they wish to make.
You are not alone

Group therapy provides community, and is therefore the natural antidote to a range of human suffering, including addiction- the disease of loneliness. Addicts tend to check out of life, out of living and out of relationships. As addictive behaviors increase, meaning and purpose in life decreases. There is no longer a pursuit of goals and dreams, as addicts gradually let go of educational or occupational activities. More importantly, addicts check out of relationships, families and communities, unless others hold the promise of a next fix or high.

There is a painful absence of meaningful human connection, and this in turn constitutes a powerful fuel for continued and escalating despair and addictive behavior. Listening, supporting and encouraging each other week after week in group therapy sessions allows participants to connect with one another, and gradually back into the healing arms of human community. We begin to belong again.

A Safe Space to Connect with Self and Others

Our feel good society may convey that we should hide ‘negative emotions’ such as despair, grief and depression, forcing us to put on a mask pretending we are ok. This is not so much for our own sake, a ‘fake it until you make it’ endeavor, but instead prevents others from the discomfort of being exposed to our suffering. The show of life must on. In stark contrast to that, group therapy participants are encouraged to identify, express and stay with a range of emotions. This is important in more ways then one way: firstly, research shows that individuals struggling with addictions or mental health problems typically cannot endure difficult emotions, such as anger, sadness, fear or boredom.

Learning that all emotions are not only acceptable, but also necessary for our well-being is a crucial step towards health and healing.  By extension, this allows for participants to connect with, and address sometimes deeply buried emotions and experiences. In doing so, or bearing witness to other participants doing so, can be powerful and sometimes life changing: we can finally stop drowning and numbing our soul’s and heart’s suffering with increasing levels of some sort of external and temporary fix.

Microcosm and laboratory

Fact is that no one comes to therapy because their life is fabulous and they are having such a good time. In contrast, we only tend to bare our souls and share our suffering when we are miserable, and when our typical ways of being in the world no longer work. Acceptance, support and safety in group therapy provide an ideal platform for experimentation with new ways of thinking, behaving and relating to others. For example, as unhelpful ways of relating to others emerge during group sessions, participants may start to explore unhelpful relationship patterns in their lives, thereby inviting baby steps towards change and perhaps healing with estranged loved ones.

The opportunity to observe fellow group participants making changes for the better, whether in regards to relationships or in other important aspects of their lives inspires others to do the same. Conversely, inspiring and supporting others to make changes for the better, we learn that we have something to offer -albeit or perhaps because of the challenges that brought us into group.

Mirror, Mirror on the Wall …

Addictions group therapy can work like holding up a mirror. Group members inevitably identify with others’ accounts of lying, deceiving or stealing from those who deserve so much better. This invites taking a hard long look at our behaviors and our lives, and in doing so, counters denial. No longer can we tell ourselves our substance or alcohol use was ‘not that bad’, or ‘not as bad as that of others’. It brings about stark awareness to those things we previously drugged, drowned or otherwise pushed down.

Such awareness demands we take ownership of the wreckage our addiction has left behind. It calls for honesty with self and others, and builds the basis for making amends and repairing relationship with hurt and alienated family and friends. With guidance and support from group facilitators and other group participants alike, we can develop the courage to face addiction-related shame and guilt, rather than take these emotions as yet another convenient justifications to use. Although painful and uncomfortable, this proves a wonderful opportunity to consider our values as to what and who is important so we can gradually re-build a life worth living

No Such Thing as ‘One Fits All’ When it Comes to Healing

Albeit vast benefits, group therapy is not for everyone. Compared to individual therapy sessions, groups bear some disadvantages that make it counterproductive, perhaps even to some degree harmful to some of us seeking help.

Group therapy is usually focused on a specific problem area, such as depression, anxiety or addiction. The skills and tools participants learn typically reflect research and clinical experience as to what is helpful to most individuals struggling with the identified issue or condition. While this makes sense, this ‘one fits all’ approach may fail to address specific individual circumstances underlying individuals’ struggles. While all group participants in an addictions focused group struggle with some form of addiction, for example, individual participants may suffer from additional issues such as mental health problems, or longstanding interpersonal difficulties. Studies have shown that failure to address such challenges often makes for a short-lived sobriety, as these unresolved issues tend to resurface and threaten participants’ fragile recovery. This does not necessarily mean addictions group therapy is not going to be helpful at all for individuals with specific concerns, but it may call for additional one to one sessions to address unique needs.

When Group Therapy Becomes Unhelpful

Group participation may become unhelpful, either for the individual or other group members, if prospective participants suffer from certain mental health problems.

Social Anxiety: Individuals with social anxiety fear anticipated judgment, ridicule or embarrassment by others. They are often consumed by anxiously anticipating future social interactions they are sure will go horribly wrong, or they think incessantly about past social interactions, berating themselves for all the supposed stupid things they have said. Rather than concentrating on group discussions and activities, such individuals tend to be intensively occupied with what to possibly say or do that will not result into the feared embarrassment when called upon by the facilitator or a fellow group member. While group therapy sessions may offer opportunity to counter such negative beliefs and fears in a best case scenario, highly socially anxious individuals may be so riled up about upcoming or past group therapy that they are unable to sleep before or after sessions. Under such circumstances, potential group participants would be much better off addressing their social anxiety one to one therapy sessions, perhaps adding group sessions at a later point.

Severe personality disorders: While there is frequent overlap between addiction and some of the personality disorders such as Narcissistic, Antisocial or Borderline Personality Disorder, these do not usually constitute an obstacle to participation in addictions group therapy. However, individuals with personality disorders so severe that they are unable to relate to, or emphasize with fellow group members, and who remain exclusively concerned about their own experiences and needs, may not be able to participate in the give and take that is vital to any group process. Such individuals may be benefit more from long-term individual therapy.

Trauma: Many individuals struggling with addiction have a history of physical or sexual violence, often perpetrated by those they felt close to and trusted. Among other things, this translates into a paramount need for emotional and physical safety, and for clear boundaries. Group therapy sessions that offer little structure, and facilitators who lack the skill to provide solid containment as to acceptable behaviors and language, can easily be triggering. For example, although spontaneous touching of another group participant to convey sympathy and support may be well intentioned, doing so may propel trauma survivor into memories of other uninvited intrusions and boundary violations. For this population, group therapy offering structure and content that is trauma specific, or at least trauma sensitive, may be a much gentler and more helpful option as compared to programs focusing solely on addiction-related topics and skills.

One-on-one sessions can also be advisable for the caretakers among us: those of us who tend to focus more on others’ needs rather than on our own. After all, group therapy provides a formidable opportunity to concern ourselves with others’ problems in order to avoid our own uncomfortable work.

Thou Shall Not Confuse: Group Therapy versus Peer Support Groups

Group therapy is not to be confused with the many forms of self-help, peer support groups and recovery communities. Like group therapy, such groups offer inspiration, hope and support to anyone in addictions recovery. They allow those new in recovery to learn from the experiences and mistakes of seasoned attendees. Over time, and with commitment, fellowships also offer an opportunity to give back, for example by sponsoring someone new to recovery, thereby further cementing one’s commitment to a sober lifestyle.

Research has shown that the support and regular contact with others who are as committed to an addicts’ recovery as the addict herself, is crucial for long-term sobriety. Needless to say, such recovery communities are therefore important. However, self-help groups do not provide a structured group environment in which individuals can safely address deep-seated and often complex issues underlying their addiction. This requires skilled facilitation and therapeutic guidance by a highly trained and experienced professional, usually only found in accredited addictions or mental health programs. Self-help or peer support groups such as AA/ NA, SMART RECOVERY or Refuge Recovery are therefore no substitute for therapy, but instead and ideally lend additional and/or ongoing support long after group therapy has ended.

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Group Therapy for Addicts: Natural Antidote to Despair

Group therapy is on the menu at most rehabs, so why is it so popular? Is it just way to save money by getting clients to do their own therapy? Or, is there a valid reason for why this approach is so widespread? Check out this post to find the answer.

The Barriers Facing Women Seeking Addiction Treatment

The evidence shows that women are often getting worse deal then men when it comes to addiction treatment. A gender responsive rehab acknowledges and addresses the needs of women entering a rehab program. Find out more about the problems facing women going to rehab and how these can be addressed.

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The Barriers Facing Women Seeking Addiction Treatment

by Hope Team

Topic at a glance:
  • Most addiction treatment programs are geared towards men, yet research shows that there are significant differences in the needs of men and women entering these facilities.
  • Gender responsive addiction treatment acknowledges and addresses the needs of women entering a rehab program.
  • Addiction treatment for women needs to be gender responsive, collaborative, utilize the power of community, and recognize the importance of relationships.
Addiction is Not Just a Problem for Men

No doubt about it – both men and women suffer greatly from the damaging effects of addiction to alcohol and drugs.

Up until recent years, substance abuse has been considered mainly a male problem. While it is true that men still outnumber women when it comes to alcoholism and illegal drug use, women are catching up.

In fact, the number of female drug abusers has increased significantly. The latter, unfortunately, also includes an increasing number of pregnant users and mothers.

Research Suggests Significant Differences in the Needs of Men and Women Seeking Addiction Treatment

Nevertheless, most research and treatment programs remain geared to male participants. In recent years, important studies have found that significant gender differences exist as to addiction and its treatment.

Women face particular problems, issues and barriers when it comes to the disease of addiction, whether related to seeking or obtaining treatment, or in regards to maintaining sobriety. A gender sensitive approach to addiction rehabilitation and recovery is therefore becoming essential in any treatment program.

What is Gender Responsive Treatment?

Gender responsive or sensitive treatment acknowledges and addresses women’s very different experiences, including internal and external barriers. These include factors such as:

  • The different physiological and psychological responses to drugs and alcohol.
  • The difference in the progression from social use to dependency.

  • Co-occurring mental disorders (which women are more prone to than their male counterparts).

  • Barriers to accessing or completing treatment.

Biology as a Barrier

Women’s alcohol and illegal substance use differs greatly from men’s in a number of ways such as:

  • Women’s use progresses much more quickly to problematic use than men’s (often referred to as telescoping) .

  • Women’s bodies have a stronger response than men to even small quantities of toxic substances (researchers suspect that women’s greater percentage of body fat may be responsible for that, as toxins remain longer in the cells, thus accumulating more to toxic levels. )

  • Women tend to experience higher levels of diabetes and cardiovascular problems than male users.

  • While fertility is often negatively impacted in both genders, women may face gynecological problems that last well beyond treatment.

  • Pregnant women, who unfortunately make up an increasing number of substance seeking women, may harm their unborn offspring through inutero exposure to drug or alcohol.

Women present with greater medical needs compared to their male counterparts when entering treatment. In addition to negative physiological impact as a consequence of using, women may face medical problems that actually paved the way for substance use in the first place. For example, research shows that women tend to suffer disproportionally from chronic pain, chronic fatigue or fibromyalgia, and women’s substance use may therefore be an attempt of coping with these chronic conditions.

Whether or not a medical condition preceded or is the result of problematic alcohol and substance use for women, the bottom line is that these illnesses ought to be addressed as part of treatment. Failure to do so may increases women’s risk of relapse.

Hidden Barriers: Relationships as Pathways, Barriers and a Relapse Factor

Many researchers examining women’s use have acknowledged the significant role women’s relationships play in the initial substance use, as well as its maintenance, escalation, or renewed use following treatment completion. For example, unlike men, women’s problematic use often starts at the encouragement of male friends or a boyfriend.

Women are less likely to seek and access treatment for problematic use if their partner is unsupportive.

Female teens are the only age group among women at par with men’s rates of problematic alcohol and/or illegal substance use. Female heroin users tend to be introduced, coaxed or pressured into intravenous use by their male partners. Women are more likely than heroin addicted men to die in the first year of intravenous use, and those that survive tend to suffer from greater rates of Hep C, TB and sexually transmitted diseases compared to men. Unwanted pregnancies are also common.

Women are less likely to seek and access treatment for problematic use if their partner is unsupportive. Not surprisingly, their likelihood of staying clean and sober even if they manage to complete treatment is also decreased if their partner continues to use, or proves unsupportive of, or indifferent to a sober lifestyle.  Researchers have those pointed out correctly that women’s substance use often starts or is maintained mediated by a wish to seek, maintain or deepen human connections.

Perhaps the Most Significant Barrier: Interpersonal Violence

Most women entering substance use treatment are victims of child sexual abuse, or other forms of interpersonal violence, such as spousal assault (often also referred to as ‘domestic violence’), sexual harassment or rape. Studies suggest that such trauma affects women well into adulthood, and in fact tends to precede women’s initial alcohol or substance use.

Many women are also subjected to violence in the context of alcohol or drug use. For example, rape, date rape and marital rape tend to happen when either victim or perpetrator are intoxicated. In the case of date rape, women don’t necessarily consume alcohol themselves, but are made defenseless through involuntary administration of odor and tasteless drugs such as GHB.

Sexual Assault and Drug Use

More than 90% of all sexual assaults and rapes are said to involve the consumption of alcohol, and most of these remain unreported or underreported. Finally, women are also more likely to experience severe and repeated sexual and physical violence as a result of excessive alcohol and illegal drug use compared to male addicts.

The experience of being violated, sometimes repeatedly, brutally and over many years specifically by those charged with caring and protecting girls and women, has many devastating effects that can translates into barriers to substance use treatment:

The impact of Interpersonal Violence and Sexual Assault 

1. Survivors of interpersonal violence have problems trusting others. This makes forming or maintaining close relationships challenging , including those with helping professionals. Studies have repeatedly revealed that the strongest predictive factor for a positive treatment outcome is the therapeutic alliance with the assigned therapist. In other words, the quality of the relationship between the substance using woman and her addictions therapist or counselor. Trauma survivors may therefore not present as guarded, which in turn requires a rather skilled therapist to work through before actual issues can then be addressed.

2. Many women experience shame and guilt as a result of being sexually violated, somehow believing that they at least contributed to, if not caused, this to happen. As a consequence, they unfortunately suffer in silence, attempting to deal with the aftermath of such horrific experiences in the secrecy of their minds rather than seeking professional help.

3. Women experience many devastating and often long-lasting effects as a consequence of interpersonal violence. Sexual childhood abuse in particular has been shown to affect women’s physical and mental health negatively up to fifty (!!) years later. Survivors suffer disproportionally from various somatic complaints, but also from increased mental health problems such as depression, anxiety, post-traumatic stress disorder or personality disorders such as Borderline Personality Disorder.

4. Female addicts tend to suffer from mental health issues to a far greater extend than their male counterparts. Research has shown that a failure to address the co-occurrence of mental health and substance use ought to be treated concurrently, or at least simultaneously and in an integrated fashion if sobriety is to last. Unfortunately, many substance use treatment centers lack the resources, such as highly trained staff, to deliver such specialized treatment.

Internal Barriers: Fear of Stigma

Notwithstanding the aforementioned background of female substance use, women tend to experience far greater negative judgment by family and friends alike. Women are well aware of the social shame and the possible disapprovals they may experience from friends, family, co-workers, employers if they do reveal their addiction problem, thus staying clear of any possibility to seek treatment.

Women with addiction are seen as a “fallen woman” and parents as ‘unfit mothers’. As such, they are deemed incapable fulfilling usual responsibilities as a loving mother, wife, daughter, or grandmother. She may be ashamed of her behavior and thus refrain from seeking help for her addiction. As a substance using woman, she is less likely to fit in the female norm of society as the nurturer and caregiver for her loved ones, capable to put her own needs on the backburner. Women who are abusing drugs may live in constant fear of losing their job, their housing, their friends, their children.

Women More Like to be Judged Harshly

While men’s open confession to having a problem with addiction may be met with support and encouragement to seek treatment, women are more prone to receive harsh judgment and stark disapproval, especially by those closest to them. This is a significant barrier to treatment, as women tend to define their lives and personal worth by the quality of their relationships. The support and continued love by those they are close to are therefore crucial for success in treatment, and in continued recovery.

Stigma is especially harsh for those among substance users who are mothers, as they rightfully fear to lose their children. Many women entering substance use treatment are mothers who are mandated by child welfare services, or motivated by child custody proceedings initiated by concerned family members. Contrary to popular belief that someone ‘has to be ready to get clean’, suggesting that mandated treatment is not effective, research suggests the contrary.

Fear of Negative Judgment Means Women Downplay their Problem

In order to avoid harsh judgment by loved ones and society at large, women may be very much inclined to downplay their use. In fact, an expectation to receive negative judgment may also be the culprit in regards to denial, the soil in which any and all addictive behavior flourishes so well. For example, increasing amounts of alcohol at the end of the day be justified as a way of ‘taking the edge of’, ‘coping with stress’, or function as a nightcap to induce sleep.

Women may tell themselves that they can easily ‘kick the habit’ once the stress is gone, and life has miraculously and effortlessly found its way back into balance. Women may only admit to problematic alcohol misuse once the disabling effects are clearly visible in their day-to-day functioning, such as repeated lateness or absences from work, failure to bring young children to school, or alcohol related car accidents.

Obvious Societal Barriers: Socio-Economics

In general, research shows that women who become addicted to drugs and alcohol have lower levels of education, and are often unable to pay for privately funded substance use treatment. It may be for this reason that women show a tendency to seek publically funded mental health rather than substance use treatments, as the former tends to be more readily available, and to no cost for participants. Finances also pay a role in women’s ability to access ongoing after care treatment, for example for chronic mental health problems requiring specialized, long-term or ongoing professional care such as the case with severe trauma, or Borderline Personality Disorder.

Women also have more family responsibilities than men. A woman is more often the one who raises children, even if she is still married or lives with a partner. Leaving the children in order to attend to her addiction may not be an option at all. Even women who are working may not find it possible to leave their work, or put their children in day care in order to attend regular appointments, or a residential treatment center. The challenge as to who takes over? equally arises for women responsible for elder care, or those volunteering in community agencies, as these are often dependent on such unpaid and dedicated work.

Women also have more family responsibilities than men.

Closely related to lack of finances, women are more likely to face uncertain or unpaid employment, and difficulties with affordable housing. Until today, women tend to receive lower pay compared to men for equal work. Recent headlines bear witness to this fact, reporting that female employees of one of the UK’s largest banks, Barclays Bank, make up to 43% less compared to their male colleagues.

The Not-So-Obvious Societal Barrier: Ignorance

The fear of being judged and rejected also coincides with health professionals, friends and families alike missing signs of addiction in women. For example, mood swings, one of the most common telltale signs of a progressive addiction may prompt others to suspect increased substance use in men rather readily, while women may be suspected of being ‘hormonal’ instead. Unsuspecting family doctors may therefore prescribe increased amounts of opioids to ease pain, or tranquilizers or benzodiazepines to ease anxiety or induce sleep, unknowingly becoming women’s legal drug dealer.

Women are in fact much more prone to misuse prescription drugs than men, but few family doctors are sufficiently trained in the field of addiction to recognize warning signs in their female patients. As a result, female patients tend to have no problems getting repeat prescriptions for highly habit-forming medications. A smooth, legal and socially accepted path to prescription drug addiction is formed.

As such, women’s addiction may progress undetected, at least in the early stages, and receive attention only when she decides to reach out for help. Others may only notice when their addiction is already ruling their lives, and until then women suffer in silence and miss opportunities for treatment. In fact, women’s addiction may become only known when they no longer can fulfill the role society still prescribes to them: that of caregivers for children and elderly family members. Fact is that most women entering treatment for substance abuse are actually mothers, many of them receiving mandatory treatment courtesy of involvement with child protection services. Losing custody of their children is the biggest motivation for going into treatment.

Minority Status as Barrier to Treatment

Such inequalities affect minority women particularly strong. Women of African American or Native American or Canadian descent, women with disabilities, or those identifying as transgender, bisexual or lesbian may be at greater risk of poverty, violence, mental health issues and problematic substance use.

Ethnic minority women are at greater risk of being victimized in human and drug trafficking alike. If they do make it into treatment, which research suggests is rather unlikely, their ethnic identities and cultural practices are typically not reflected in conventional addictions programming. For example, the definition of family according to some of the Aboriginal North American communities involves not only extended family members, but their community at large.

Culturally appropriate treatment of an addicted individual would thus involve traditional healing circles and practices as much as the participation of this larger circle of support, including their elders. It is thus important to remember that women amongst themselves are a diverse group, with individual women differing greatly as to their ethnic, socio-economic and relational circumstances and treatment needs.

Implications for treatment

So, if women’s substance use, their background and circumstances differs so significantly from men’s, what are the implications then for treatment providers?

Collaborative Care

Most generally, treatment programs that acknowledge and reflect an understanding of the multiple and complex ways in which female substance use differs from those of their male counterparts, are likely to show increased positive treatment outcomes for women. For example, studies showed higher rates of long-term sobriety for female program participants if services providers offered assistance with finances, housing, transportation and childcare.

Programming that helps addressing problems confounding women’s substance use, such as enduring mental health problems or trauma, may translate into increased hopes of women affected by these multiple difficulties that treatment will bring about long-lasting change for the better. This also goes for significant medical problems, such as HIV or HEP C, or other life diminishing physical conditions such as chronic pain or fibromyalgia. Comprehensive treatment in such cases involves collaboration between short- term addictions focused treatment organizations with medical and/or community professionals involved in women’s lives and women’s care long-term.

Gender responsive treatment

Many residential addiction treatment centers remain mixed, geared towards both men and women. While this may make sense in logistically and economically from a service providers’ point of view, it fails to take into account the many needs women bring to treatment that are so different from those of men seeking recovery. For example, research has shown that women who have experienced abuse from a male perpetrator may not feel comfortable with male co-participants in group therapy, or with male therapist. Additionally, women also experience barriers to recovery as many approaches to addictions treatment are based on research with male participants, and/or on male centered..

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Episode 38 – Childhood Sexual Trauma
Nuggets from this Episode of the Podcast
  • Childhood sexual trauma is never the child’s fault.
  • Symptoms for adults who have experienced childhood sexual abuse can include: low self-esteem, trust issues, guilt, shame, poor relationship decisions, drug addiction, eating disorders, and sexual problems.
  • Children who have been physically abused usually believe, ‘they don’t love me because I’m worthless” while children who have been sexually abused believe, “they love me because I’m worthless’.

A conversation between Yuriko and Paul.

In this episode of the podcast, Yuriko discusses childhood sexual trauma. It is believed that one out of every four girls, and one out of every six boys suffer this type of abuse. Many of these kids will turn to drugs a way to cope as they get older.

It is definitely possible to build a good life and enjoy healthy relationships following childhood sexual abuse, but it will usually require time to heal and appropriate support.

You can listen to our conversation now by pressing play below:

Hope Mindful Compassion Show – Episode 38
  • How do we define ‘childhood sexual trauma’?

  • What makes an event ‘childhood sexual trauma’? (i.e. is it what happened or is it how the child perceived what happened?)

  • Is it common for clients who come to rehab to also be dealing with issues related to childhood sexual trauma?

  • How does experiencing childhood sexual trauma impact people as they get older?

  • What kind of symptoms do people experience?

  • Is it always necessary for clients who come to rehab to face any issues surrounding childhood sexual trauma?

  • What if a client’s attitude towards this past trauma is, “I don’t want to think about it”?

  • Is it possible for people to have experienced this type of trauma in childhood to not remember it but still be affected by it?

  • Is it possible to fully recover from childhood sexual trauma?

  • How do people recover? (e.g. do they always need therapy?)

  • What advice would you give listeners who are currently dealing with this issue?

  • Can you recommend any resources? (e.g. books, YouTube videos, websites etc.)

Recommended Resources

Adult Survivors of Child Abuse Anonymous

Hungry for Touch: A Journey from Fear to Desire by Laureen Peltier

You can also listen to the podcast on iTunes

If you found this episode of the podcast useful, please share it on social media. 

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Episode 38 – Childhood Sexual Trauma

In this episode of the podcast, Yuriko discusses childhood sexual trauma. One in four girls and one in six boys are said to suffer this type of abuse. Is there a way back from this type of experience? What is the relationship between childhood sexual abuse and addiction?

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When given the choice between sitting alone in silence or receiving electric shocks, most of us would choose the electric shocks. It is hardly surprising that boredom is a huge risk for people leaving rehab. Buddhism provides a solution that doesn’t involve feeding our addiction to stimulation.

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The post Episode 38 – Childhood Sexual Trauma appeared first on Hope Rehab Center Thailand.

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A Buddhist Response to Boredom
Topic at a Glance:
  • People tend to prefer even pain over boredom.
  • Those of us recovering from an addiction may be more likely to relapse due to boredom than something bad happening.
  • Boredom arises due to an ‘addiction’ to stimulation – if our only response is to ‘stay busy’ we may be just feeding this addiction.
  • The Buddhist anecdote to boredom is curiosity.
Even Electric Shocks are Preferable to Boredom

Image by Daisuke Tashiro

Most people when given the choice between sitting alone in silence or receiving electric shocks would choose the electric shocks. This was the conclusion of a study from the University of Virginia where participants choose mild voluntary shocks over being alone with their thoughts.

This preference for pain over boredom is something many of us will have experienced for ourselves – at least I hope it isn’t just me. I clearly remember back in my school days jabbing a compass point into my hand because I was so bored in class. Even more embarrassingly, as an adult, I got a rolled-up ball of paper jammed in my ear because I put it in there for something to do.

What is Boredom?

Boredom is the subjective feeling that nothing interesting is happening in our current environment. It is a lack of stimulation that triggers negative thoughts and low mood. Feeling bored is unpleasant, and it is understandable that we would want to escape it.

Boredom is a Common Relapse Trigger

I remember in my first rehab being told about the dangers of boredom for people like me. My usual response to ‘having nothing to do’ was to pick up a drink, so I needed to keep myself busy. It appears most of us who quit drugs are more at risk of relapse due to boredom than something bad happening.

What works for us at one point in our life doesn’t necessarily suit our needs further down the road. The advice to ‘keep busy’, helped me get through those early days of life without alcohol, but it wasn’t much of a solution to boredom. I was addicted to stimulation in much the same way I had been addicted to the booze. Keeping myself busy was like treating my addiction by continuing to drink.

Addiction to Stimulation

It’s sometimes hard to remember a time before mobile phones. How did we ever manage without 24-hour access to games, videos, music, email, and social media? How did we get through sightseeing trips without spending most of the time taking photographs to upload to Instagram? Did people really used to have family dinners where each member of the family wasn’t regularly updating their Facebook page?

We are now used to the constant entertainment provided by smartphones and other devices. Many of us are addicted. We develop a tolerance for stimulation in much the same way as we develop a tolerance for drugs. This means that it takes increasing levels of stimulation to prevent us from experiencing boredom. Feeding this addiction doesn’t work in the same way as feeding any other addiction wouldn’t work.

All of humanity’s problems stem from man’s inability to sit quietly in a room alone.

Blaise Pascal

The Importance of Being Able to Experience Stillness Without Distraction

Not only does boredom trigger self-destructive behaviors (such as substance abuse or sticking rolled-up paper balls in our ear), but our inability to sit quietly means we are missing out.

Some of the benefits of being able to sit quietly include:

  • It means we can see things more clearly.

  • Creative ideas are more likely to arise from a still mind.

  • Our brain is more likely to cough-up a solution to a problem if we just sit in silence (this is far more effective than trying to think our way out of a problem).

  • It allows us to relax and let go of tension.

  • Sitting in silence subjectively slows down time – this gives us the space to take a breath and appreciate our life.

  • If we want to gain insight from meditation, we need to be able to tolerate lack of stimulation.

A Buddhist Understanding of Boredom

From the Buddhist perspective, boredom arises due to the habit of the mind to label experience as either pleasant, unpleasant, or neutral. This labelling is referred to in Buddhism as ‘vedana’  or feeling tone.  Boredom arises when we are in any situation where the most obvious feeling tone is neutral.

It is important to stress that there never is anything inherently boring in anything we are experiencing. It is just the feeling tone that is being currently triggered. The label the mind chooses in any given situation depends a lot on our conditioning. For example, some people will see a football match on TV, and the feeling tone will be pleasant, for other people the feeling tone will be neutral or even unpleasant.

A Buddhist Response to Boredom

To be able to overcome boredom, we need to see beyond the conditioned feeling tone. We do this by becoming more interested in what we are experiencing at this moment. Curiosity is the magic sauce – it forces the brain to reevaluate its application of the ‘neutral’ label. Over time, we begin to see that anything we give our full attention to appears interesting. Even something as simple as the breathing becomes a wonderous experience when we approach it with curiosity.

The key to beating boredom it to become curious about what we are experiencing rather than to try to change the experience.

One of the nice benefits of regular meditation is that we train ourselves to find lack of stimulation interesting. Because of this, we start to experience deep states of stillness that soothe us. We get a taste for peace. We realize that it is this stillness that we most deeply yearn for and not the tension of being constantly stimulated.

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The post A Buddhist Response to Boredom appeared first on Hope Rehab Center Thailand.

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Escaping my addiction: Why just moving wasn’t the right move
The topic at a glance
  • It is very common for addicts to try to escape their addiction by moving to another city/country/continent – however, these attempts usually fail.

  • Chris uses his own experience of several geographical changes that he tried to overcome his addiction with to explain the missing puzzle piece.

  • The key to how moving away can actually be a life-saving step on your way to recovery.

By Chris H.

On a hot August afternoon, I jumped into my car and took a deep breath. The aches, cold sweats, and vomiting were showing no signs of letting up anytime soon. I was deep in opiate withdraw, and feeling the full effects of it. When my car started a familiar yellow light alerting of the critically low fuel flashed, and I needed to make $20 take me on a 3-hour drive. The rush was on to leave before my roommates got back from work, so they didn’t chase me for the rent that was two months overdue or find out that I’m leaving – for good. “This is it; this will fix you,” I thought to myself.

The problem: Moving alone was just a temporary fix as I was still bringing myself along

I was doing something very common among addicts – using a geographical relocation to try to cure my addiction. No matter if it was the next state over or the other side of the world, the result was the same – until I finally realized the missing piece years later. Just six months into abusing prescription opiates, I knew I needed to make a change. I had recently failed out of university and began working a job in retail. Although I liked the job, I still massively struggled with coping with my recent failure at school and to cope I turned to opiates. I tried multiple different ways to stop using opiates, and nothing worked. The only solution I saw was to relocate back to my hometown and live with my parents. I can still remember that five-hour drive quite vividly. My back seat loaded with my very few possessions, thinking “I got this”. But again it’s back to the problem – I was still bringing myself along.

The next rock bottom left me in a worse place than before

To be completely honest – it was effective for a while. I excelled in work, I settled down into a relationship, and everything seemed to be going swimmingly, and I quickly forgot about my using days. After a while, when work and my relationship became stale, the thoughts of using began to creep back in, and I had no effective tools to fight that voice with. Rock bottom came quickly, and in a matter of a month, I was in a much worse place than before I had moved. It quickly escalated from prescription opiates to heroin and even began injecting. This lasted for a long time, and a few years later thought I would try to change where I lived again, but this time much farther away.

Every time I moved, I was switching one addiction for another

I got an opportunity to work in Southeast Asia, and immediately took it as my chance to clean up. I moved overseas and settled into the new culture well. I had that same thought – I got this, and I repeated that critical error – I brought myself along. I followed the exact same path. For a few months, I did extremely well, focusing on work and living my life. What I realize now is that every time I moved, I was switching one addiction for another. Drugs were replaced with the adrenaline of working and being in relationships. The problem here is that once those replacements stop being effective – when a new job becomes mundane, or you have a problem with your partner – the only solution is to drink or use. And this is what happened to me yet again. I began seeking prescription pills and even though I knew the path it would take me, I didn’t have the tools to say no. Just like the first time, I fell much harder than before. I used drugs I never thought I would and did things I never thought I would to get them.

How we talk ourselves into believing that moving is the right move – and why it doesn’t work

All I was doing was getting away from my old problems in one area, and starting to create a whole new set of problems in a new location. When considering moving, the focus is on all the negative aspects of our current living situation. We tell our self that there are too many bars, or my dealer lives too close to me. We insist that one particular family member or friend is contributing to our addiction. All we are doing with this is blaming our addiction on outside influences, and strongly believe that without them – with different life circumstances – we would not need drugs and alcohol. No matter where we go, we will always handle life the same way. We will react the same way to a boss telling us we need to work harder. We react to the same way when someone rejects us. Bills and rent still need to be paid on time. All of the little things that we were unable to deal with still exist, and we simply do not change. When considering a move, it’s important to examine the motives – are we truly looking for a solution, or are we just trying to escape?

Moving to escape addiction allows us to not have to deal with our problems anymore – but it’s temporarily

At its core, a common component of addiction is escapism. We can’t handle life – whether its work, relationships or paying bills, we can’t do it. Drugs and alcohol are a way for us to escape that. When the drugs are active, we don’t have to deal with all of those issues. Geographical changes are just another way of doing this. When we move, we get away from all the problems we had caused, such as damaged relationships, using friends, and problems in our workplace. But moving doesn’t make those problems go away; it’s just a way to temporarily not have to deal with them anymore. This creates a very unhealthy pattern that perpetuates our addiction.

Why changing location actually often leads to an accelerated drug use and drinking

Along with the internal problems of relocating, there are logistical problems that go along with it. Sometimes the things we are trying to escape are beneficial. While some family and friends are harmful to us, others provide a much-needed support network. We rely on them for emotional and mental support in difficult times, and moving away means leaving that behind, and finding a way to replace that support network can be very difficult to do. Often though, to the addict, this is seen as an advantage. Think about when someone first goes to college. All of a sudden, you’re out on your own, out from under your parent’s roof, and you have the freedom to do what you want when you want. Similarly, when you move to a new area, there’s nobody to call you out on your past behaviours. People simply don’t know you or your patterns. While this is seen as “freedom”, it is quite detrimental for any sort of recovery and can often accelerate drug use and drinking.

We often forget about the stress that geographical changes bring to our lives

Another major logistical problem is the stress of moving itself. If you have ever relocated to a new city, it can be one of the most stressful things to go through. There are so many things that have to get done and be taken care of – you have to find a place to live, find a new job, pack all your old things, get bills set up, change your ID, and of course find new friends around you. This undue stress can be too much for many to bear, and often results in drinking or using the minute we relocate since we have little to no coping strategies for stress.

The right move: How a geographical change can be a life-saving tool for addiction

While there are many downsides to using a geographical change as a primary way to fix your addiction, if it’s used correctly it can be a life-saving tool. A major advantage is that you are able to remove yourself from your old using grounds and take yourself out of your day to day life and stresses. Relocating in conjunction with behavioural work is one of the most effective methods for long-term recovery. This way, you can work on yourself in a safe environment.

The missing key: How – in the end – a move helped me to start my life recovery

My last geographical change was the only successful one. Before my move to Thailand, I was beaten, broken and down in a completely foreign country. When considering it, I was very scared that it would be just like the other times, and just turn out to be another failed attempt at getting clean. Thankfully it wasn’t, and I used the change of scenery to my advantage. So what did I do differently? For starters, I used relocating as a tool for recovery instead of an entire solution. I realized that all of the outside influences – work, location, and friends – were not what was causing my addiction, it was me. I checked into treatment – a place I would have a full support team and the time to work on some of the core issues of my addiction. The main thing was that I was ready to work on myself and recognized that I had to if I wanted any sort of long-term recovery. I used the change in location to give me a break from life and take care of the things that were keeping me using.

Now I’m almost two years clean, and I handle life in a much different way. One of my biggest problems was not being able to deal with minor everyday issues, and learning various tools of Cognitive Behavioural Therapy (CBT) helped me tremendously. No longer are there racing thoughts, catastrophizing any speed bumps that could potentially come up – just solutions and effective ways forward. Along with CBT, I also attend local support groups. These groups are an amazing place to be able to bring any problems and speak about them with a group of people who understand me and can relate to me. With these tools, I’ve been able to handle breakups, financial problems, job-related problems, and issues with family and friends in a healthy and constructive manner. Finally – a geographical change that worked!

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Forgiveness: A Gift We Can Offer Ourselves
Topic at a glance:
  • Is forgiveness a sign of weakness? Does it mean becoming a doormat?
  • Why would we forgive people who have hurt and abused us?
  • Letting go of the past is easier said than done. How can we learn to forgive?
Forgiveness Isn’t a Sign of Weakness

I haven’t always been a fan of forgiveness. The mere mention of this word used to grate on my nerves. It felt like such a weak response to being wronged. So, let me get this straight, I’m supposed to give those who hurt me a free pass? That’s never going to happen.

Even worse, was when people would tell me to ‘forgive myself’. WTF. My standard response to anyone suggesting this was for them to go hug a tree and quit bothering me. What I needed was to stop being such a pathetic failure, so self-forgiveness was the last thing I needed – if anything, I had to be tougher on myself to get my loser-ass moving.

It took many years and a great deal of pain before I realized that forgiveness isn’t a sign of weakness. It is instead a gift we can offer to ourselves.

What is Forgiveness?

Forgiveness isn’t so much something we do as something we realize. It is the recognition that we suffer unnecessarily when we hold on to grudges and resentments. The person who initially wronged us will usually be completely unaware of the turmoil in our head. We alone suffer when we are unable to let go of resentments, and we do it to ourselves.

The inability to forgive keeps us in a relationship with our abusers. We may not have physically seen these people for years, yet they continue to be there in our thoughts. How is this helpful? Forgiveness is the recognition that we have already devoted too much time these people, and we now need to let them go.

Forgiveness Does Not Mean That What Happened Was Okay

The biggest barrier to forgiving other people is the belief that this is the same as saying that what they did was okay. This is not what is meant by forgiveness. It is merely the insight that we have already suffered enough. We all must face the consequences of our actions, and forgiveness doesn’t change this. It just means we stop adding to that initial harm.

Forgiveness doesn’t necessarily mean allowing people who have hurt us back into our lives. It’s not about becoming ‘best friends forever’ with our abusers. There are dangerous people out there, and we would be wise to avoid them, but we don’t have to carry the weight of hating them.

The Key to Forgiveness is Understanding

There was a disturbing video of a dad terrorizing his 7-year old son that went viral here in Thailand a few years ago. At one point, this grown man had his hands around his son’s neck and lifted him off the ground. It was horrible to watch.

My initial reaction, and it seemed to be the common reaction of most people responding on social media, was one of revulsion and anger. For a minute or two, I would have gladly joined a lynch mob to hunt that pathetic excuse for a human being down and string him up.

But then I remembered something…

There but for the Grace of…

When my son first arrived in the world 10 years ago, we didn’t get much sleep. After a few weeks of this, I was walking around like a zombie. Totally exhausted. Then one afternoon, I was alone with my son, and he just wouldn’t stop crying. I felt so helpless, and it was like I was going insane. I adored my son, but for a few seconds, there was an urge to shake him angrily. I didn’t do it, but the urge was there.

This memory helped me realize that happy, well-balanced people don’t go around lifting 7-year old’s up by the neck. This kind of thing happens when our coping strategies are overwhelmed, and we lose the ability to react rationally. Some of us have such poor coping strategies that we are easily overwhelmed, and this means we are more likely to horrible things. This is in no way meant to be an excuse for bad behavior, but this understanding can make it easier to forgive it.

Self-Forgiveness is Not Limited to Tree Huggers

I initially found it much easier to forgive other people that to forgive myself. It didn’t help that guilt about my past behaviour was so much a part of my inner soundtrack that I hardly noticed it anymore. There was also the fear that if I were to forgive myself for past behaviour, it would only encourage me to repeat these mistakes. It turned out it was my misunderstandings about forgiveness that made it seem New-Agey and self-indulgent.

Self-Forgiveness Means Facing Our Dark Side Without Flinching

Self-forgiveness is the ability to face the darkness inside of ourselves without using it as an excuse to beat ourselves up. This takes courage. It becomes easier to do when we recognize that none of us is perfect. As humans, we are subject to be powerful inner drives that can cause us to be selfish, abusive, and highly destructive. Mental health means we can better control these harmful impulses, but these impulses are there in all of us.

Our past bad behavior may seem crazy to us now, but we need to remember that who we are now is not who we were back then. We live and learn. Self-forgiveness is the recognition that we have always tried our best – even when this ‘best’ was horrendously bad. It is easy to behave in a saintly-fashion when things are going our way, but when life becomes a struggle, the more destructive impulses can gain the upper-hand unless we have appropriate coping strategies.

Self-Loathing is a Lousy Motivational Tool

It turned out that repeatedly rubbing my own nose in the manure of my past failures wasn’t such a great motivational tool. Who would have thought it? Rather than fueling self-improvement, the crippling guilt would leave me feeling hopeless and overwhelmed. This negative mental state caused further bad behavior which gave me more things to feel guilty about.

We all fall-down in life, but self-forgiveness is where we stand up and brush ourselves off. It is this that allows us to do better in the future. As I say, we learn from our mistakes and move on. This is far more useful than guilt which keeps us stuck in the past.

Self-Forgiveness is Not a ‘Get Out of Jail Free’ Card

Self-forgiveness means not only admitting to our own fallibility but also accepting the consequences of our bad behavior. We reap what we sow. If there are negative consequences coming our way, we can leave it to life to sort all that out. We don’t need to feel guilty and beat ourselves up. This helps nobody. Self-forgiveness means we can face these consequences gracefully and focus our attention and repairing any damage.

How to Forgive

It is by accepting our own fallible nature that we become able to do the same for other people. We start to see the futility of holding onto resentments, and this makes it easier to let go of them.

One of the practices that people find helpful when learning to forgive is loving-kindness (metta) mediation. This technique helped me let go of a lot of guilt and resentment, so it may be worth giving it a try.

Click on the link to find out more about metta meditation.

If you agree that forgiveness is a gift, you could help us by sharing this post on social media.

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The post Forgiveness: A Gift We Can Offer Ourselves appeared first on Hope Rehab Center Thailand.

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Phuang Malai – The Thai Flower Garland
The topic at a glance
  • What is a Phuang Malai?

  • What is the meaning and purpose of these Thai flower garlands?

  • How to make a Phuang Malai yourself

By Paul G.

Phuang Malai is the local name for a flower garland that you will almost certainly see during your stay in Thailand. This symbol for luck and respect is found everywhere – you will see hanging from the rear-view mirrors in motor vehicles, placed at shrines, and most business premises will have phuang malai (sometimes shortened to simply ‘malai’) hanging around somewhere. These garlands are made from fresh flowers daily, and you will see them on sale at markets, street stalls, and almost any red traffic lights that has a decent amount of traffic (they usually cost 20 THB).

Meaning of Phuang Malai

In Thai, the word phuang means a ‘string’ or ‘bunch’ and ‘malai’ means ‘garland’. We have to be careful when talking about ‘phuang malai’ though because these same words can also mean ‘steering wheel’.

To avoid confusion, it is best to specify ‘phuang malai rot yon’ when talking about a steering wheel (rot yon means motor vehicle). There are different theories as to why the steering wheel is called ‘phuang malai’ – it may have something to do with its resemblance to a popular garland that has a round shape like a bracelet.

Purpose of Phuang Malai

It is impossible to know exactly when local people first developed their love for phuang malai, but these garlands were definitely in common use around the time of King Rama V (mid-nineteenth century). Back then, the ability to create these beautiful garlands earned great honour, and it was expected that all women of the Thai royal court mastered this skill.

Nowadays, phuang malai are used for many purposes including:

  • Hung in motor vehicles for luck and with the hope of reducing the risk of accidents – these garlands can also be used to pay respect to any other holy statues/ornaments also kept in the vehicle.

  • Offered to Buddhist statues or statues of Hindu gods as a way of paying respect and earning merit.

  • Worn by the bride and groom at wedding ceremonies.

  • Offered to important visitors and dignitaries.

  • Used by business people to attract luck and pay respect to any shrine they may keep on the premises.

  • Offered to spirit houses as a way to stay on the right side of dead relatives.

  • Offered to monks as a way of showing respect.

There are different designs used to create phuang malai – but the main difference is that some are designed in a way that it can be worn like a bracelet while others are designed to be draped around the neck or another object (malay song chai).

Create Your Own Phuang Malai

Making your own phuang malai can be a nice thing to do, and it is a way to express your artistic side. You will need some flowers, ribbon, a needle, and cotton thread. The idea is to carefully push the thread through the flowers – the exact way you do this will depend on your design. The ribbon is used to connect different chains of flowers. You will need to be patient and focused if you want to do this right– so it’s a wonderful mindfulness practice.

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The post Phuang Malai – The Thai Flower Garland appeared first on Hope Rehab Center Thailand.

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Negative Thinking Patterns: How to identify, understand & break them
The topic at a glance
  • Negative thinking patterns & negative self-talk – where do the come from and how to deal with them

  • 8 common negative thinking patterns

  • The solution to negative thinking patterns

by Simon Mott

I once heard someone say addicts are “egomaniacs with an inferiority complex”. This struck a chord with me. In my head, I can still have negative thinking patterns, a dialogue that includes unhelpful self-talk springing from irrational core beliefs.

After years of CBT and working on my negative thinking patterns I realise at a deeper level my negative core beliefs turn in on me and degrade me. But before they do this they turn on the world and other people. I read about ABC model, and it goes something like this…

Thought 1 – anxiety at situation (catastrophising)

Thought 2 – anger at others (blaming)

Thought 3 – self-pity with self (self-loathing)

Some common negative thinking patterns
Why does it always happen to me?

They call this personalising; I call it bad luck or superstitious thinking, probably not rationally looking at the real causes of a situation. Apply unfairness rather than taking responsibility.

 I don’t care…

This is usually denial because we all do care at some level. However, it helps relieve uncomfortable feelings when we don’t get what we want.

Life is shit anyway!

Filtering out the positive for sure, this is an effort to absolve us from our part. The universe has conspired against us. That is why our life is not satisfactory.

 The blame game

It is an auto-reaction. It is instinctive to blame, including blaming others for their sins. But it is for the most part unhelpful, as when we do this all we do is give all our power away to the one we blame.

 Judge, jury and executioner

Judging is instinctive but also negative when we judge others self-righteously as we are setting ourselves up to be a hypocrite. Applying humility would be better.

 Must and should

Rigid thinking leaves us cornered like a rat sometimes. Flexibility is not weakness it gives us options.

 It is all going to go wrong anyway so why bother?

This is strategic pessimism. Maybe it is guarding against disappointment. To stay safe, we reduce our expectations to such a low point we are paralysed.

 I can’t trust or rely on anyone

High expectations on other human beings are a common mistake, and this is why we suggest getting a higher power that cannot let us down.

Negative Thinking Patterns – The Solution

So what do we do now we have identified our negative thinking patterns? I suggest writing them down on a piece of paper and then next to them write down the healthy thoughts. These will be your affirmations, and it really helps to repeat them daily for a while. Very soon you will not only remember them but, automatically, when you get negative thinking patterns, your new, improved thought patterns will counter them.

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The post Negative Thinking Patterns, Self-Talk and Beliefs appeared first on Hope Rehab Center Thailand.

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