I always ask patients about drug and alcohol use.
Often times, someone will tell me that they drink alcohol or smoke marijuana "socially" or "on weekends" or "average". I always follow this up with more questions about how much this really amounts to.
Often times, this amounts to a pattern of either daily use, or quite frequently of having binges at least once a month, sometimes once or more per week.
It is quite clear from a medical point of view that binge drinking is psychologically harmful: not only does it place someone in a position of higher risk for physical accidents (I do not have to search my memory far to think of tragic alcohol-related deaths or severe head injuries among young students in the prime of their life), the pharmacological effect of this type of usage will exacerbate all mood and anxiety problems. It will interfere with normal sleep for long periods of time after the binge is over, and if there is a mood-related or anxiety-related sleep problem already, it can push the symptom intensity up much higher and make it much more difficult to treat.
I have found that many people, upon describing their pattern of binge drinking or marijuana use, will say that their behaviour is part of normal, ubiquitous university culture, i.e. "everyone does it."
Here is what some statistics show from a local part of a large recent continent-wide survey of university students:
Percentage of students who actually have never used marijuana: 63%
Students' belief about what percentage of fellow students have never used marijuana: 16%
Percentage of students who actually use marijuana daily: 1 %
Students' belief about what percentage of fellow students use marijuana daily: 16%
Percentage of students who have actually never used alcohol: 16%
Students' belief about what percentage of fellow students have never used alcohol: 3%
Percentage of students who have used alcohol daily: 0.1%
Students' belief about what percentage of fellow students have used alcohol daily: 30%
All of these above figures show that students greatly overestimate how much their fellow students are drinking and using marijuana. Because of how powerful the influence of social pressure is, especially to young people, it is important to be reminded of the facts. It is much more the "norm" for students to drink or use marijuana rarely, if at all. And it is common -- not rare -- to be completely abstinent.
However, one concerning figure from the same study shows that about 40% of male students, and 30% of female students, have had 5 or more drinks in one sitting at least once in the past month. This is a binge. And this is associated with the greatest risk of physical and psychological harm. For almost 10% of students, binge drinking occurs 3-5 times per month, which is more or less on a weekly basis. This type of behaviour is certainly a prelude to a more severe future of alcoholism, with all its physical and psychological sequelae.
Based on my reading of epidemiological studies, it is clear to me that 2 drinks per 24 hours is the maximum quantity of alcohol reliably consistent with good health (it may be that this level of alcohol consumption actually confers health benefits compared to abstinence, at least for some people).
I am not convinced that any amount of marijuana use is consistent with good health, except perhaps for some people who may have used it just a few isolated times in their lives, in a good mood, in a pleasant environment, which may have helped them relax some of their inhibitions or gain some other insight about themselves or the world. It is more often the case, though, that such experimentation leads to negative health effects.
Friday, August 15, 2008
Thursday, August 14, 2008
Internet Addiction
It has come to my attention, both in my practice, and in a recent review of results from a large survey, that many people are using the internet so much that other areas of their life are suffering.
For university students in particular, a high percentage of individuals report that their internet use is adversely affecting their grades.
The internet can gobble up time in numerous ways: if you are bored, you can find an endless stream of connections that can keep your mind absorbed with new tangents.
Many people use the internet to communicate with others. The internet can be a wonderful technological aid which fosters closeness, expands our community of friends and peers, etc. But it can also cause us to be so absorbed in the activity itself -- of talking to friends, or perhaps to strangers -- that hours of time pass by. Sometimes these hours are spent online when they might otherwise have been spent visiting a friend in person, doing a healthy activity outside, studying, etc. Sometimes these hours are spent in the middle of the night, instead of sleeping.
There are other addictive lures that may snag people's attention, including games, gambling, and porn. Perhaps all of these activities allow people to enjoy certain aspects of life with greater freedom and discretion. But they can be very addictive, in the sense that a relationship can be formed with the activity, at the expense of other life relationships (e.g. with other friends or loved ones, with work, with school, with other interests, with physical self care and exercise, etc.).
So I'm not saying that the internet is bad. But I encourage people to be careful not to be involved with a computer in an addictive way, in a way that is interfering with other life activities and relationships.
To some degree this is a cultural issue -- our modern culture is changing, and the computer is becoming increasingly a part of it. This may be integrated in a way that is healthy and part of a new "normalness", just as any new technological innovation changes behaviour and culture (from the invention of the wheel or of fire, to the printing press, to the automobile, to the TV, etc.). There are those who resist any cultural change, or pronounce it to be unhealthy. So the internet is here to stay, and I hope can remain an enhancement to our culture -- but we need to learn ways to participate in the culture in a way that is safe and healthy, and to be aware of its dangers (just as we need to be aware of the dangers of fire, wheels, or the automobile).
As a formal challenge, I encourage people to try a month without using the internet at all, and to assess how life is different during that time.
I have made a similar challenge to people about TV, to turn it off completely for a month, then to review any differences in the way they feel.
I recognize the irony that I am making these statements in a forum only available on the internet!
For university students in particular, a high percentage of individuals report that their internet use is adversely affecting their grades.
The internet can gobble up time in numerous ways: if you are bored, you can find an endless stream of connections that can keep your mind absorbed with new tangents.
Many people use the internet to communicate with others. The internet can be a wonderful technological aid which fosters closeness, expands our community of friends and peers, etc. But it can also cause us to be so absorbed in the activity itself -- of talking to friends, or perhaps to strangers -- that hours of time pass by. Sometimes these hours are spent online when they might otherwise have been spent visiting a friend in person, doing a healthy activity outside, studying, etc. Sometimes these hours are spent in the middle of the night, instead of sleeping.
There are other addictive lures that may snag people's attention, including games, gambling, and porn. Perhaps all of these activities allow people to enjoy certain aspects of life with greater freedom and discretion. But they can be very addictive, in the sense that a relationship can be formed with the activity, at the expense of other life relationships (e.g. with other friends or loved ones, with work, with school, with other interests, with physical self care and exercise, etc.).
So I'm not saying that the internet is bad. But I encourage people to be careful not to be involved with a computer in an addictive way, in a way that is interfering with other life activities and relationships.
To some degree this is a cultural issue -- our modern culture is changing, and the computer is becoming increasingly a part of it. This may be integrated in a way that is healthy and part of a new "normalness", just as any new technological innovation changes behaviour and culture (from the invention of the wheel or of fire, to the printing press, to the automobile, to the TV, etc.). There are those who resist any cultural change, or pronounce it to be unhealthy. So the internet is here to stay, and I hope can remain an enhancement to our culture -- but we need to learn ways to participate in the culture in a way that is safe and healthy, and to be aware of its dangers (just as we need to be aware of the dangers of fire, wheels, or the automobile).
As a formal challenge, I encourage people to try a month without using the internet at all, and to assess how life is different during that time.
I have made a similar challenge to people about TV, to turn it off completely for a month, then to review any differences in the way they feel.
I recognize the irony that I am making these statements in a forum only available on the internet!
Tuesday, August 12, 2008
Boredom
The feeling of boredom may be a signal to change what we are doing, to seek something more stimulating or pleasurable.
Many signals that the brain gives us are helpful guides, which lead us to make better decisions.
Other times, the signals the brain gives us are misleading.
In the case of boredom, the brain may be conditioned to expect a lack of stimulation or pleasure in a given activity. And it may be conditioned to expect stimulation or pleasure by leaving this activity. If this behavioural pathway is followed, it may further lead to a conditioning effect, in which the initial activity feels even more boring the next time round. It is like the forest path again, and each time you go down the path, it becomes more established.
I believe that in many cases the brain causes us to leave experiences prematurely. There might be much more pleasure, stimulation, and meaning in activities that are felt to be boring, but the brain is too habitually eager to get us out quickly, to the alternate activity.
As an exercise, I encourage practicing ways to discover interest, stimulation, meaning, and pleasure, in activities that you have pronounced to be boring (e.g. working through a textbook for school; getting through a work shift; commuting; conversing with someone who isn't your favourite person, etc.). It may require looking at the experience in a different way, with an eye to find significance, meaning, and interest, rather than focusing on the aspects that you find tiresome.
One very specific way to discover this change of perception is to take a class in drawing, painting, or photography -- often part of the experience is of learning to see things in a different way, to become absorbed with interest in something you thought was mundane. Another technique is to take courses in meditation, in which one can learn to be more at peace with the present moment, even while sitting quietly with almost no external stimuli.
In my work with students, I believe this is an extremely important issue. Many students have enrolled in a course of study that may last at least four years, or may lead to a lifetime career. Yet they are bored with what they are doing. I strongly encourage choosing courses (or other life decisions) that have a hope to be interesting, and coming to the work with an attitude of finding significance, meaning, and interest, rather than expecting or continuing an experience of boredom. Boredom leads to disengagement, a fractured relationship with what you are doing, and can be the beginning of lifelong unhappiness with the present moment.
While you may need to make external changes, it is important to make a strong effort to direct internal changes too.
Many signals that the brain gives us are helpful guides, which lead us to make better decisions.
Other times, the signals the brain gives us are misleading.
In the case of boredom, the brain may be conditioned to expect a lack of stimulation or pleasure in a given activity. And it may be conditioned to expect stimulation or pleasure by leaving this activity. If this behavioural pathway is followed, it may further lead to a conditioning effect, in which the initial activity feels even more boring the next time round. It is like the forest path again, and each time you go down the path, it becomes more established.
I believe that in many cases the brain causes us to leave experiences prematurely. There might be much more pleasure, stimulation, and meaning in activities that are felt to be boring, but the brain is too habitually eager to get us out quickly, to the alternate activity.
As an exercise, I encourage practicing ways to discover interest, stimulation, meaning, and pleasure, in activities that you have pronounced to be boring (e.g. working through a textbook for school; getting through a work shift; commuting; conversing with someone who isn't your favourite person, etc.). It may require looking at the experience in a different way, with an eye to find significance, meaning, and interest, rather than focusing on the aspects that you find tiresome.
One very specific way to discover this change of perception is to take a class in drawing, painting, or photography -- often part of the experience is of learning to see things in a different way, to become absorbed with interest in something you thought was mundane. Another technique is to take courses in meditation, in which one can learn to be more at peace with the present moment, even while sitting quietly with almost no external stimuli.
In my work with students, I believe this is an extremely important issue. Many students have enrolled in a course of study that may last at least four years, or may lead to a lifetime career. Yet they are bored with what they are doing. I strongly encourage choosing courses (or other life decisions) that have a hope to be interesting, and coming to the work with an attitude of finding significance, meaning, and interest, rather than expecting or continuing an experience of boredom. Boredom leads to disengagement, a fractured relationship with what you are doing, and can be the beginning of lifelong unhappiness with the present moment.
While you may need to make external changes, it is important to make a strong effort to direct internal changes too.
Friday, August 8, 2008
Music & Repetition
Life is full of repetition.
Life problems, including many of those associated with depression, involve a lot of repetition, and monotony.
Symptoms recur. Relationship problems recur. Problematic themes recur.
We often seek to end the repetition.
Sometimes it is necessary to end the repetitive cycles, if we can see them.
Other times, I think one can work with repetition in a similar way as occurs in music.
Music is repetitious. The rhythm or beat may be constant. Various accompaniments may be the same throughout. Themes within a piece of music may continuously recur. Without some degree of repetition, a musical piece would seem confusing or aimless. Changes, colourations, variations, and harmonies can transform monotonous repetition into a beautiful and dynamic composition. Repetition itself may not be the problem.
I encourage the idea of managing some recurrent life themes in a musical way --your repetitive theme could be part of a meaningful composition. Also, a musical approach may permit you to work through the old theme, say goodbye to it, and introduce something new.
Life problems, including many of those associated with depression, involve a lot of repetition, and monotony.
Symptoms recur. Relationship problems recur. Problematic themes recur.
We often seek to end the repetition.
Sometimes it is necessary to end the repetitive cycles, if we can see them.
Other times, I think one can work with repetition in a similar way as occurs in music.
Music is repetitious. The rhythm or beat may be constant. Various accompaniments may be the same throughout. Themes within a piece of music may continuously recur. Without some degree of repetition, a musical piece would seem confusing or aimless. Changes, colourations, variations, and harmonies can transform monotonous repetition into a beautiful and dynamic composition. Repetition itself may not be the problem.
I encourage the idea of managing some recurrent life themes in a musical way --your repetitive theme could be part of a meaningful composition. Also, a musical approach may permit you to work through the old theme, say goodbye to it, and introduce something new.
Activation Energy
In chemistry, there are atoms or molecules that can react very strongly with one another, perhaps leading to a new molecule, or to a release of energy.
Yet, these particles may not react, unless they have a sufficient energy, the "activation energy".
The activation energy is like a fence to climb over before you can ski down a hill. Often times, the reactions don't happen in our lives, because we do not climb over the fence, we do not reach the activation energy.
Some reasons for the activation energy phenomenon may be that some particles need to be "pushed together" energetically in order to react. You may need to push yourself sometimes into an action that ends up being extremely meaningful and self-sustaining.
Other reasons for an activation energy barrier could be "geometric". For example, a key or a puzzle piece may fit, but it has to be placed in just the right way, at just the right orientation or angle, in order to work. Pushing harder and harder will not solve this problem. Sometimes we push ourselves, things seem not to fit, but it is because we are approaching the problem at the wrong angle.
Catalysts are things that reduce the activation energy barrier. Sometimes the fence in front of the hill is too tall to climb. A catalyst is like a gate in the fence. Or it could be an environment in which things fit together more easily (e.g. it could be like having surrounding portions of the puzzle done for you, permitting you to more easily place your piece with more clues).
Behaviourally, we must be willing to invest "activation energy" into new actions and ideas. The resulting reaction may pay off, and return much more energy and meaning.
We must also search for, and be willing to use, catalysts. A social catalyst might be a friend, who could help introduce us to new friends. Or it might simply be a place where you feel comfortable -- such as a community centre, school, coffee shop, church, etc. The physical place may be a catalyst to help you meet a new friend, or attain greater social comfort.
I think therapy is a catalytic process in many ways, in that it may not always provide energy for action directly, but could help provide a "surface" in the form of a therapeutic frame, a place to re-organize our orientation to things, permitting reactions to more easily occur.
Yet, these particles may not react, unless they have a sufficient energy, the "activation energy".
The activation energy is like a fence to climb over before you can ski down a hill. Often times, the reactions don't happen in our lives, because we do not climb over the fence, we do not reach the activation energy.
Some reasons for the activation energy phenomenon may be that some particles need to be "pushed together" energetically in order to react. You may need to push yourself sometimes into an action that ends up being extremely meaningful and self-sustaining.
Other reasons for an activation energy barrier could be "geometric". For example, a key or a puzzle piece may fit, but it has to be placed in just the right way, at just the right orientation or angle, in order to work. Pushing harder and harder will not solve this problem. Sometimes we push ourselves, things seem not to fit, but it is because we are approaching the problem at the wrong angle.
Catalysts are things that reduce the activation energy barrier. Sometimes the fence in front of the hill is too tall to climb. A catalyst is like a gate in the fence. Or it could be an environment in which things fit together more easily (e.g. it could be like having surrounding portions of the puzzle done for you, permitting you to more easily place your piece with more clues).
Behaviourally, we must be willing to invest "activation energy" into new actions and ideas. The resulting reaction may pay off, and return much more energy and meaning.
We must also search for, and be willing to use, catalysts. A social catalyst might be a friend, who could help introduce us to new friends. Or it might simply be a place where you feel comfortable -- such as a community centre, school, coffee shop, church, etc. The physical place may be a catalyst to help you meet a new friend, or attain greater social comfort.
I think therapy is a catalytic process in many ways, in that it may not always provide energy for action directly, but could help provide a "surface" in the form of a therapeutic frame, a place to re-organize our orientation to things, permitting reactions to more easily occur.
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