Charlie Sheen Substance Abuse: FAQ

By Stephanie Watson


March 1, 2011 — After actor Charlie Sheen trashed his suite at New York’s Plaza Hotel, called Chuck Lorre, the creator of the TV show “Two and a Half Men,” a “turd,” and rambled incoherently in a television interview about being a “high priest Vatican assassin warlock,” people started to wonder whether the TV star had come completely unhinged.

Sheen has admitted to a history of drug use, but is his erratic behavior a sign that he’s still addicted and in denial, or that he’s also dealing with a mental illness? Sheen certainly isn’t the first celebrity to deal with drug addiction. If it turns out, as some experts have speculated, that he’s also got a mental illness, he similarly wouldn’t be alone in having both conditions.

WebMD asked addiction experts about the connection between mental illness and substance abuse. What’s the link? What can happen when someone who is addicted refuses to get treatment? And what are the best ways to overcome an addiction?

What’s the Connection Between Addictions and Psychiatric Disorders?

Addiction and mental illness often go hand in hand. Up to half of people with depression, bipolar disorder, or another mental illness also have a substance abuse problem.

Experts say having one of these conditions increases your vulnerability for the other. “If you have a lifetime addiction and have taken drugs over a long period of time it can affect your psychiatric functioning,” says Bruce Goldman, LCSW, CASAC, program director of the Project Outreach Clinic in West Hempstead, N.Y.

Conversely, people with mental illness often use drugs and alcohol as a way to cope. “People will self-medicate, and that may be a risk factor for starting an addiction,” says Elizabeth Howell, MD, a board-certified addiction psychiatrist at the University of Utah Neuropsychiatric Institute.

The addictive substance itself can cause symptoms that mimic mental illness. Being high or going through withdrawal from drugs can make you feel anxious, angry, or restless, which are also common signs of psychiatric conditions, Goldman says.

Why Are Addictions So Hard to Overcome?

The reason why drugs like cocaine and heroin are so quick to lead to addiction is the effect they have on the brain. When you smoke cocaine, for example, you get increased levels of dopamine and serotonin– brain chemicals that give you feelings of pleasure.

Then suddenly, that good feeling is gone.

“You’re on this roller coaster where you feel this extreme dopamine spike and then you have a crash and you want more,” Howell says.

Having an untreated mental illness can make an addiction even harder to shake. So can having a lifestyle that makes drugs easily accessible, which is why so many celebrities, like Sheen, are always making headlines.

What Happens if You Don’t Get Treated for Addiction?

When actor Martin Sheen was interviewed about his son’s drug problem, he called it “a form of cancer.” Is addiction really like a disease? Howell thinks it is. “Addiction is a disease process, and we know that the diseased organ is the brain,” she says.

Just like cancer or any other serious disease, addiction can become life-threatening if it’s not treated. “It is a potentially fatal disease, and I’ve seen people die from overdose, from complications, from poor judgment — accidents,” Howell says.

Which Treatment Works Best for Addiction?

That depends on the addiction. Cocaine withdrawal is typically treated supportively and does not always require medication or hospitalization. Medications can help withdrawal symptoms for some addictions.

Cognitive behavioral therapy helps people recognize the situations where they’re most likely to use. Motivational incentives provide good reasons to stay off drugs.

This broad range of therapies allows for a very individualized treatment approach. “I truly believe that there’s no best treatment for everyone, and different treatments work better for different problems and different individuals,” Goldman says.

What’s most important is that you recover in a supportive setting where other people are also trying to get clean, Howell says.

Depending on the addiction, treatment may start with a medically supervised withdrawal, commonly called “detox,” to get you off the addictive drug. Then you need to completely abstain from not only your drug of choice, but other drugs too.

Whatever you do, don’t try to treat yourself for an addiction.

Though Sheen claims to have cured himself with “the power of my mind,” Howell says trying to self-treat for an addiction is a dangerous prospect. 

“It doesn’t work,” she says. “As a psychiatrist, I’ve been trained in how to do psychotherapy, but I never do psychotherapy on myself. If you’re a surgeon you don’t take out your own appendix. You have to have an outside person or support system helping you who has a perspective that you can never have for yourself.”

How Are People With Both Addiction and Mental Illness Treated?

Treating addiction without addressing the underlying mental illness isn’t enough.

“Many years ago when we were treating addiction, we had the false belief that if you treated the addiction and waited, some of the psychiatric problems would resolve themselves. We no longer believe that,” Goldman says. “You really need to treat both of them simultaneously to be effective.”

Considering that so many people who show up for addiction treatment also have a mental illness, centers today are well equipped to deal with both conditions.

What Should You Do if a Family Member or Friend is Addicted?

If you suspect that a family member or friend is addicted to drugs or alcohol, try to get them help. “I think if you’re concerned about someone’s health and safety, you’re compelled to step in and intervene to see that the person gets help,” Goldman says.

There is a chance the person will try to avoid facing the problem, especially if he or she also has a mental illness. It’s common for both drug users and people with conditions such as bipolar disorder to deny there’s anything wrong with them.

If your friend or family member refuses treatment, it’s hard for you to do much more, unless the situation is spiraling out of control.

“Some states do have laws that allow you to commit someone who is addicted and out of control and potentially harmful to themselves because of their addiction,” Howell says.

How Can People Stay Clean After An Addiction?

Once you’ve gone through treatment, you need begin the process of learning how to live without drugs or alcohol. That can be hard, especially if you’ve relied on the substance — or substances — for years.

Sheen says he just “blinked and I cured my brain.” But getting clean is never that easy.

“There’s no magic to it. It’s a long, arduous road,” Howell says. “It’s a chronic problem that’s going to be with people throughout their lives.”

Part of overcoming addiction involves changing your perspective, and starting to see your addiction not as something you’re going to be “cured” from, but as something you’ll have to work on throughout your life.

“Addictive disorders are chronic diseases. In other chronic diseases, such as diabetes, we don’t measure success in absolute terms over the course of a lifetime. It’s similar with addictions,” Goldman says.

The longer you stay in treatment, the better your odds for success.

“People have to be convinced personally,” Goldman says. “They have to be very motivated and committed to living a drug- and alcohol-free lifestyle.”

Source WebMD

Why the Recession May Trigger More Depression Among Men

By ALICE PARK


It’s a well-established fact that women are at higher risk for depression than men, but that may soon change, says a psychiatrist at Emory University.

When Dr. Boadie Dunlop began recruiting subjects for a depression study, he enlisted the help of local sports radio shows, and was surprised by the tremendous response he received — from men. “We were really impressed with the number of men coming in with depression related to employment or marital conflict,” says Dunlop.

That led to discussions about the many social and cultural changes occurring in gender roles that may put men at increasingly higher risk of developing depression, which Dunlop outlines in an editorial in the British Journal of Psychiatry.

The most recent recession brought some of those issues to a head, he says, as downsizing and higher unemployment highlighted the death of manufacturing and labor-intensive jobs, which have traditionally been held by men. About 75% of the jobs lost in the downturn belonged to men. Innovations in technology, as well as outsourcing to countries where manual labor is less expensive, are shrinking this sector, forcing more men than women out of work. With men culturally shouldering the role of primary breadwinner for their families, unemployment hits men particularly hard, as their self-esteem, an important factor in depression risk, is often contingent on their role as provider.

At the same time, on a more psychological level, societal norms about the male image are changing, shifting away from males as the stoic breadwinner to a more realistic model of a member of a family who is just as prone to emotional and psychological stress as any other member. This change is making it easier, albeit only slightly, for men to talk about conditions such as depression, and may lead to a bump in incidence as more men start to feel comfortable talking openly about the mental illness.

Traditionally, women have had up to twice the risk of developing depression over their lifetime as men, and the reasons are both biological and social. Biologically, differences between genders in hormone metabolism account for some of the susceptibility to depression; culturally, the higher rates of childhood abuse among girls is also a factor in enhancing rates of depression among women. As adults, women have also been confronted with societal barriers to professional self-fulfillment that have had a negative impact on their self-image and self-esteem. But as more men either share or relinquish their role as primary earner in households, they may feel the same threat to their sense of self as women historically have. In addition, as more men take on child-rearing responsibilities, they may feel inadequate and overwhelmed, fertile ground for depression.

“Men are going to be taking on these roles, some by choice and some will have it forced on them,” says Dunlop. “How well will they be able to adapt, and how well we are able to help them if they have troubles with those roles?”

Socially, he says, despite many high profile cases of men admitting to depression, such as Mike Wallace and John Cleese, it’s still difficult for most men to acknowledge feeling overwhelmed and out of control. “To be depressed, to feel overwhelmed and not motivated to do things, are signs that have had the stigma attached to them of mental weakness,” says Dunlop. “And men traditionally have felt that they should just overcome them and snap out of it.”

Acknowledging that men are facing some profound economic and societal changes that could negatively affect their self-esteem is the first step that could help more health-care providers address the issue, he says. For family practitioners or other non-mental health specialists, simply asking about how their male patients are coping with the economic downturn, and whether the financial crisis has caused any changes in his family, is a good start. “A general inquiry about how you are getting by can open the door to how his role has changed, and whether he is finding things tough going,” says Dunlop.

Being aware of the cultural and economic shifts that may make men vulnerable to depression may also end up addressing an important question in mental health circles — how much of the greater vulnerability among women is due to biology, and how much to the sociocultural environment in which they live? If men and women continue to show divergent rates of depression even as gender roles become equalized — as more women become providers and more men take child-rearing responsibility — then it’s likely that nature may trump nurture with respect to depression. But if the rates start to match up, then, says Dunlop, it could suggest that our environment plays a more dominant role in triggering the mental illness. And that, in turn, suggests that there may be things we can do to address it. “If men are taking on different roles, they may need help in learning how to do it,” he says. Providing that help could lead to lowering their rates of depression.

Source Healthland

Why Daydreamers Are More Creative

By Scott Barry Kaufman


In 1966, my mentor and colleague, Jerome L. Singer, published his seminal book, “Daydreaming: An Introduction to the Experimental Study of Inner Experience.” Since then, the scientific study of daydreaming has taken off. A key theme that has emerged is the striking continuity between nightdreaming and daydreaming and the ability of creative people to harness this continuity.Neuroscience has allowed us to take this research to new, creative heights that were unimaginable when Singer published his book in ’66.

When most of us fall asleep, the brain network that involves attention to the outside world (the working memory network consisting primarily of the lateral frontal and parietal cortices) deactivates and our default brain network (medial prefrontal and posterior cingulate cortices) takes over. The discovery of the default brain network is important, as it involves various aspects of our self, such as our self-representations, dreams, imagination, current concerns, autobiographical memory and perspective-taking ability. Those with higher default network activity during rest have a tendency to daydream more frequently, which makes sense if one thinks of the default network as involving our inner stream of consciousness.

When most of us awaken, our working memory brain network re-engages, and our default brain network recedes into the background. In most people, the working memory network and the default network “anticorrelate” with each other, meaning that when one network is activated, the other is deactivated. This is generally a good thing! Proper connectivity (i.e., communication) between the two networks allows people to know when it’s important to distinguish between pure fantasy (their inner stream of consciousness) and “reality” (the external world).

But that’s most people. Creative folks and those with schizophrenia tend to have an overactive default network. Prior research has suggested that the thing that seems to differentiate creative but functional individuals from those in a mental institution is that the functional folks appear to have the ability to engage both brain networks, and they can use their working memory network to control their attention. Those who lose grip on reality and become paranoid and delusional have let the floodgates down, so to speak, letting too much of their default network control their attention.

A recent fascinating experiment takes things to the next level. The researchers investigated the functional brain characteristics of participants while they engaged in a working memory task. Importantly, none of their subjects had a history of neurological or psychiatric illness, and all had intact working memory abilities. They administered two different versions of the same working memory task during the fMRI scanning session, one version requiring much more concentration than the other. Their more difficult working memory task required constant updating of information in memory while having to resist distraction.

Participants were asked to display their creativity in a number of ways: generating unique ways of using typical objects, imagining desirable functions in ordinary objects and imagining the consequences of “unimaginable things” happening. The creativity test they used has been linked in prior studies to Openness to Experience and frequency of visual hypnagogic experiences (e.g. lucid dreaming, hallucinations), which in turn have been associated with vividness of mental imagery.

The researchers found that the more creative the participant, the more activity in their default-mode network was altered. Particularly, creative individuals had difficulty suppressing the precuneus area of their default network while engaging in the more effortful working memory task. The precuneus is the area of the default network that typically displays the highest levels of activation during rest (when a person is not focusing on an external task). The precuneus has been linked to self-related mental representations and episodic memory retrieval.

How is this conducive to creativity? According to the researchers, “Such an inability to suppress seemingly unnecessary cognitive activity may actually help creative subjects in associating two ideas represented in different networks.”

Intriguingly, prior research has shown a similar inability to deactivate the default network among those with working memory deficits, as well as schizophrenic individuals and their relatives (who are more likely to have schizotypy). The key to functional creativity, then, seems to be the ability to keep one’s internal stream of consciousness “on call” while being able to concentrate on a task.

In a related interesting and informative article for The Wall Street Journal entitled “Bother Me, I’m Thinking,” Jonah Lehrer discusses the importance of distraction for creativity. He discusses a recent study showing that A.D.H.D. is associated with creative achievement. He also mentions a study conducted by Shelley Carson and her colleagues at Harvard in 2005, which found among a sample of high I.Q. individuals that eminent creative achievers (as eminent as can be under the age of 21!) were seven times more likely to have reduced latent inhibition. Latent inhibition is a filtering mechanism that we share with other animals, and it is tied to the neurotransmitter dopamine.

Lehrer defines “latent inhibition” as the ability to focus, such as being distracted by an air conditioner while trying to solve math problems. But this is not quite right. Technically, latent inhibition involves the ability to consider something as relevant even if it was previously tagged as irrelevant. A reduced latent inhibition allows us to treat something as novel, no matter how may times we’ve seen it before.

In my own research, I found that latent inhibition and an intellectual cognitive style are not related to one another; intelligence and latent inhibition seem to be independent abilities (at least in people with a normally functioning working memory system). I also found that those with a reduced latent inhibition have more confidence in their intuitions. This is probably because those with a reduced latent inhibition actually havemore accurate intuitions!

So instead of strictly measuring distractibility, latent inhibition tasks measure a form of mental flexibility. It’s not that people with a reduced latent inhibition always treat the irrelevant as relevant; it’s just that they consider everything as potentially relevant. And this is conducive to creativity because sometimes the seemingly irrelevant is relevant!

This distinction is subtle, but really important. I have seen too many journalists confuse the meaning of latent inhibition. My colleagues — such as Shelley Carson, Oshin Vartanian, Liane Gabora and Darya Zabelina — and I have been investigating the ability of creative individuals to switch modes of thought depending on the task demands. This is a very exciting new area of research!

The way I see it, it’s not distractibility, per se, that is the most relevant thing for creativity. Instead, I think the key is to keep your wonder and excitement for the world, being open to everything in the environment as well as your own internal stream of consciousness. I think putting things in these terms allows for more useful practical applications.

I agree with the spirit of Lehrer’s call on his blog for a greater appreciation of “impulsive expression” in the classroom. But I’m not sure teaching students to exhibit more A.D.H.D. is the right way to go. I think it’s more reasonable to teach people in society (including the classroom and workforce) to be open and mentally flexible and encourage the use of imagination while still maintaining the ability to concentrate. We don’t have to promote either working memory skills or imagination and daydreaming. We can promote both. And in so doing, we are promoting true creativity — creativity that is both novel and useful.

Source Psychology Today

How to Cultivate Humor

By Nando Pelusi


Humor doesn’t typically come to mind in the same breath as depression. But humor can be an important ally in getting beyond the rigidity of thinking that accompanies depression and keeps people locked into a depressed state of mind.

One goal of cognitive therapy is to change your perspective, your point of view. Humor is one way to change your view viscerally—and enjoyably.

Cultivating a humorous mindset helps you see yourself and any situation with a more supple mind so that you are not locked into a negative view. Depression is both caused by and causes the inability to see options and choices we otherwise would.

Take a common situation: someone feels very depressed in the wake of having failed at something. They cancel plans and withdraw from social opportunities. They don’t feel “up to it.” Under the surface, perhaps out of view of the conscious mind, the person might feel that the failure disqualifies him from the human race. However, turning around and asking out loud, “Does that disqualify me from the human race?” is humorous. It highlights the absurdity of the extreme conclusion.

We’re not talking stand-up comedy, but insight-oriented commentary, achieved via anecdote and metaphor. You might feel down from a cutting remark your spouse made. But you could ask yourself: Does that “cutting” remark draw blood? Noting the metaphor puts it in its place—an obnoxious comment, but not a searing one.

Humor fosters acceptance of our humanness and our foibles. It is not sarcasm or put-downs. What we are looking for is gentle, playful perspective that embraces humanness but never at the expense of others—or of ourselves. The goal is not to take life too seriously.

So how to foster good humor?

  • Choose to allow yourself to laugh at your own behaviors and beliefs—but not at yourself. Make that distinction clearly.

    See your life not as a distraught drama but as a romantic comedy. Recognize the inherent farce-like quality in situations including sex and relationships.

    Cultivating humor not only makes life more bearable, it makes you more attractive to others. Study upon study shows that a sense of humor is high up on the list of traits that most people seek in a partner.

  • Insert silliness. Fill your life with one goofy thing a day. Make an unusual observation about someone. Or do something you normally wouldn’t do. Wear something silly. You will learn that nothing terrible happens—and you may also discover that something good often happens.
  • Puncture a rigid mindset with a mental exercise called “paradoxical intention.”

    Suppose you have to give a speech and you are unduly anxious about looking uncomfortable. You can overcome the fear of failure by deliberately focusing on it and humorously exaggerating the very effects you fear.

    Say you are worried about having to speak publicly and sweating profusely. Deliberately imagine a humorous situation where you are—literally—sweating like a fountain and spewing enough to drown the first row of the audience. Accept that you sweat like a fountain; imagine it and then think, what is the worst that could happen?

  • Exaggeration is funny because it skewers the falsehood. If you fail at a test or perform poorly at an audition, you could erroneously call yourself a failure. That, however, is an overgeneralization. Alternatively, you could see yourself as someone who failed at this particular thing, but in no way does that stamp you forever in this way.

    Find the humor by saying, this makes me an utter wretch, a failure now and forever, a doomed and worthless subhuman, because I didn’t get the part that I wanted or my partner isn’t giving me the attention I want. Get into the exaggeration until you see the absurdity of seeing yourself as a “total failure.”

  • Walk down the street remembering that people are nude under their clothes. It reduces fear of others. Such thoughts can take people of high status from deity to human. It helps to remember that everyone yells at their kids, spills ketchup, goes to the bathroom.
  • Play to an audience. Think of stories and items that would make others laugh.
  • Be sensitive to the words you use. They can rigidify or help loosen up your thinking.
  • Create cute, funny neologisms with your partner. Call it goofifying. Creating your own funny expressions for your experiences makes you more flexible and allows you to interpret and assess reality better.
  • Smile. Here’s a favorite silly joke I can’t resist passing along: What does an agnostic, dyslexic insomniac do? Stays up all night and wonders if there is a dog.

Source Psychology Today

Necessary Endings

By Dr. Henry Cloud


In my work as a clinician, a leadership consultant, and a fellow sojourner, I have found something to be true: in both our personal and professional lives, it is often the exact same issues that can hold us back, or even derail us. Find a control freak at home, and chances are that their their co-workers have the same complaints that the spouse has. Or, if someone is an enabler in their love life, they are also a boss who doesn’t confront poor performance. In short, we usually don’t have personal issues vs. work issues…what we really have are “me” issues. And they show up wherever we are. Which brings me to our topic: Necessary Endings.

In both the personal and professional life, there are times when reality dictates that a person must stand up and “end” something. Either it’s time has passed, it’s season is over, or worse, continuing it would be destructive in some way. The situation requires someone to:

• Fire an employee who should be fired
• End a dating relationship that is not going to go where they need to go
• Shut down a product line or a business unit (remember GM’s troubles?)
• Get out of social ties and activities whose “season has passed”
• Letting go of a dream that is not going to materialize and moving on
• Leave a job or a career that they know is not right, or is even toxic for them
• Ending a marriage with repeated unfaithfulness that is not changing
• Admit that something is failing and waving the white flag
• Unplug from toxic friendships or family ties
• Giving up on an addict who does not want to change

But too many times, with clear evidence staring them in the face, people find it difficult to pull the trigger. Why is that?

The reasons are varied, but understandable, especially in light of developmental psychology, our understanding of trauma, and cognitive mapping. Some people’s developmental path has not equipped them to stand up and let go of something. For example, if they did not develop what psychologists refer to as secure attachment or emotional object constancy, the separation and loss that ending a relationship triggers for them is too much, so they avoid it. In addition, in their development they may not have been taught the skills to confront situations like these. 

Or, if they have had traumatic losses in life, another ending represents a replay of those, and they shy away or frantically try to mend whatever is wrong, way past reason. Or they have internal maps that tell them that ending something is “mean” or will cause someone harm. In any case, fears dominate their functioning, and they find themselves unable to do a “necessary ending.” See if you can relate to any of these fears or inabilities that can cause people to hang on or stay somewhere too long:

• You can’t tell if an ending is actually necessary, or if “it” or “he” is fixable
• Being afraid of the loss and the sadness
• Fearing the confrontation
• Fearing the unknown
• Lacking the skills to execute the ending
• You lack the right words to use
• You fear hurting the person
• You have had too many painful endings in your personal history and don’t want another one
• You’ve blown endings before, and don’t want to repeat it one more time

Probably all of us can relate to something on that list. But even so, here is the issue: endings are necessary. They are an essential part of life. Everything has seasons, and we have to be able to recognize that something’s time has passed and be able to move to the next season. And, everything that is alive requires pruning as well, which is a great metaphor for endings. Gardeners prune a rose bush for three reasons:

1. The bush produces more buds than it can sustain, and some good ones have to go so the best ones can have the resources of the bush
2. There are some branches and buds that are sick and not going to get well
3. There are some that are already dead and are taking up space

So, let’s apply that to life:

1. Over time, you gather more activities, relationships, work, interests, etc. than you can really feed with the best of your time and energy. You have to realize that you cannot go deep with everything, and figure out which ones you are going to invest in.
2. Face it….there are people who you have tried everything with to get them to “get it,” or businesses/strategies where you have also tried everything and there is no reason to keep throwing good money after bad.
3. And, there are people, places and things around which have been dead for a long time, and it is past time to let go.

Therefore, we have a dilemma: life and success require “necessary endings,” and we are afraid to execute them. That equals a conflict worth solving. So, what to do?
In future blogs I will talk a lot about this topic from my new book “Necessary Endings”, but for now, lets start with a few thoughts:

• Consider how you look at endings in general. Do you perceive them as natural? Do you have a world view that everything has its season and life cycle, or do you think that if something comes to an end it means that “something must be wrong?”
• When you see that you need to let go of something, or a person, what happens inside? What fears emerge? How paralyzing are they? What can you do to address them?
• Have you really thought about the fact that if you don’t do the pruning in that area that is needed, then you won’t get what you ultimately want? For example, if you keep that employee then that department will never perform well? Or if you stay in that dating relationship you will not find the one that fulfills? Play the movie forward a year or two and see if you like the results of not making a decision.
• If you are holding on to hope, what is the basis for that? Is it rational and objective? Or is it just a defense against facing the issue?

Endings are a part of life, and we are actually wired to be able to execute them. But because of trauma, developmental failures and other reasons, we shy away from taking the steps that could open up whole new worlds of development and growth. Take an inventory of the areas of life that may need some pruning, and begin to take the steps that you need to face the fears that are getting in the way. If you do, you might find yourself getting unstuck and entering into a whole new season of life.

Source Psychology Today