All posts by gabbert2013

About gabbert2013

I have been a psychotherapist for 20+ years. I specialize in Marriage & Family Therapy and addictions. My practice name is Interactions Therapy Center. I've learned a few things over the years and hope you'll find these blogs interesting.

Change is Possible, But the Hard Part is Sustaining It

I’m a psychotherapist and an addiction counselor. I’m frequently asked whether change is possible. The short answer is yes, but sustaining change is the hard part.

The rate of relapses among people who set goals is high. Perpetrators of domestic violence are reported to be violence free up to three years after treatment. Figures vary on substance addictions, but approximately 40-60% will relapse. 97% of dieters regain what they lost within 3-5 years. How many New Year’s resolutions have never taken root? How many of your life aspirations have never been fulfilled? It is human nature to return to our set point, or comfort zone.

As a species, we don’t adhere to professional treatment recommendations. 30-50% of people with type 1 diabetes fail to stick with their treatment plan. 50-70% of people who suffer from asthma fail to take their medicine. 50-70% of people with chronic high blood pressure don’t take their hypertension medication as directed. Medication non-adherence leads to worsening of disease, death and increased health care costs. The extent of non-adherence is 10-92%. There are three types of medical non-adherence. First, are prescriptions that are never filled. Second, is non-persistence, in which the patient’s stop a medication after starting it without professional guidance. Third, is non-conforming in which medications are not taken as prescribed.

Whether it is medical non-adherence, or behavior change, we are all at risk of failing. Here’s what doesn’t work.

  • Intentions alone are not sufficient to sustain change. Excitement fades.
  • Negative emotions such as fear-based behavior change doesn’t work. We all experience negative emotions such as regret, shame, fear and guilt when we don’t live up to our ideals. These emotions may serve as a reminder of what we’d rather be doing, but negative emotions are the least effective change strategies. For example, scolding a heavy drinker won’t cause them to stop drinking.
  • Feeling overwhelmed by a desired change leads to all-or-nothing thinking. Break down your goal into achievable components. Don’t try to change too much at one time. Change is rarely just one thing; it’s a lot of connected things, and sustained change doesn’t happen without a consideration off all the steps.
  • Information is not sufficient. Information is only as useful as what you do with it. You can know something and still do nothing. Well-intentioned advice does not produce motivation for change.

How long does it take to change a habit? We’ve all heard that it takes 21 days to create a new habit but in reality, no one knows. Some things stick after you’ve done them once, others take more persistence. Complex goals are more difficult to achieve than simple ones.

There is a saying that if you fail to plan, you plan to fail. Here’s what does work.

  • Commit yourself to a change program. If that program is not working any longer, recommit to another method that has the same end goal.
  • Make your goal known and be accountable to your support network.
  • Create a relapse prevention plan. Look ahead to any scenarios that could lead to relapse and have a step by step plan for how you will handle it.
  • Make a list of your relapse triggers. Triggers are the things that could get you off track. Catch slips before they become larger losses.
  • Have a list of tools that will get you back on track.
  • If you fail badly, assess the damage and find ways to correct it.

If you have lost your motivation, do the things that keep you interested in your goals. Review the reasons you wanted to achieve this goal. Or, immerse yourself in the topic by reading material about the desired change. Talk to your support network.

Sustainable change requires time, self-discipline, and energy. For example, I can teach couples new communication techniques and help them understand each other’s beliefs, perspectives and emotional pain. But couples who make changes in their relationship need a plan in order to sustain their changes. I ask them to set tasks that will serve as a reminder to stay on track. Perhaps they schedule a date night weekly, put it on the calendar, and take turns finding a babysitter. Or, have a scheduled “state of the marriage” conversation monthly. Or, attend a marriage retreat yearly. I even recommend that they keep post-it notes on their refrigerators to remind them what they need to work on. Without these tasks, they will likely return to their old behavior.

If you continue to fail at your desired change, you may benefit from a coach or therapist to keep you on task.

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Harvey Weinstein Doesn’t Know Consent from Coercion

Harvey Weinstein, is an American film producer and former film studio executive. He and his brother Bob Weinstein, co-founded Miramax, which produced several popular independent films. You may be familiar with Pulp Fiction, Clerks, The Crying Game, and Sex, Lies, and Videotape. He has been in the news headlines recently with dozens of accusations of sexual harassment and assault, including rape, occurring over 20 years. He is paying the consequences. He has made settlement payments to some women who made allegations of sexual abuse, his wife is divorcing him, the Academy of Motion Picture Arts and Sciences has expelled him, and he was removed from the company he founded. The evidence implies that he wrongfully committed sexual assault on numerous occasions. However, he made a statement that all of these sexual incidents were consensual. His victims disagree.

This is a good time to remind people what sexual consent is. Emory University published a guide to a non-assaultive relationship called “Consent, Not Coercion”. I have reproduced it here.

Consent is when someone agrees, gives permission, or says yes enthusiastically to sexual activity with someone else. Central to the concept of consent is the understanding that every person has a right to control their body, and to not be acted upon by someone else in a sexual manner unless they give clear permission to do so. The person initiating the sexual activity is responsible for obtaining permission from the person or persons they want to engage in sexual activity with. Consent is always freely given, and every person involved in a sexual situation must feel that they are able to say “yes” or “no” at any point during sexual activity. Absence of clear permission means you can’t touch someone, not that you can.

In most cases, consent should be a clear verbal agreement. However, if a person is seeking consent from someone who cannot communicate verbally, they should obtain consent using another agreed upon method of communication. Non-verbal communication includes sign language, writing or typing messages, gestures, nodding or shaking one’s head, and blinking, to name just a few.

Consent is
not:

Body language: If a person makes eye contact, smiles, leans in, sits close to, embraces, or touches someone else in a manner that might be perceived to be friendly or even flirtatious, it does not automatically mean that the person is asking to engage in sexual activity or consenting to it.

Power differentials: When one person holds significant power over another person (i.e., boss/employee or professor/student), it is more difficult to be sure that this difference of power is not influencing any sexual interactions between them.

Dating relationships or previous sexual activity: Simply because two people are dating or have had sex before does not mean that consent is automatically present. Both must always feel they have the right to say no to sex.

Marriage: Even in marriage, consent can never be assumed. Marital rape does exist, and it is just as severe as any other sexual assault. In Georgia, there are marital rape laws that make a sexual assault in a marriage a crime.

Being drunk: Alcohol consumption can render a person incapable of giving consent. Perpetrators often use alcohol as a weapon to target individuals and as a means of excusing their own actions. Emory’s sexual misconduct/Title IX policy and Georgia laws apply to a perpetrator regardless of whether or not they were drinking.

Coercion is a tactic that perpetrators use to exert power and control over another person. Coercion occurs when a person intimidates, tricks, forces, or manipulates someone into engaging in sexual activity without the use of physical force. Perpetrators may also use threats of violence, blackmail, drugs, and/or alcohol to coerce someone into sexual activity.

According to MensWork, a Louisville, Kentucky based nonprofit, legal and healthy consent requires six things to be in place. Equal power and status; both are cognizant and are agreeing to the same thing; both have an understanding of the consequences; neither are under the influence of drugs and alcohol; it respects the legal age of consent; and both partners respect a change of mind without question and without coercion.

If you are still unclear about what constitutes sexual consent, watch a video called “Tea Consent” on Youtube.com. Even if you are clear on sexual consent, watch the video.

Are You a Cat Person or a Dog Person?

I am a dog person. I met my husband at a dog park. Our dogs are considered family members. We take them to work, on vacations when possible, and spare no expense for their medical needs. And while I have a preference for dogs, this is largely determined by my cat allergies. If I wasn’t allergic to cats, I would include felines in our family. But I am also a bird person. We’ve had a handful of birds from parakeets and cockatiels to a Macaw that will outlive us.

If we divide people into just two groups, cat people and dog people, which would you be? You may identify yourself as one or the other based upon preference whether you have a pet or not, whether you had a pet in the past, or whether you have both animals. The assumption is that you acquire a pet because they fit their your personality. While this is not always true, it might provide interesting insight into yourself.

Sam Gosling of University of Texas conducted a study in 2010 on personality traits of each group. Gosling surveyed people on the Five Factor personality traits of openness to experience, conscientiousness, extroversion, agreeableness, and neuroticism. The researchers concluded that dog people tend to be more social and outgoing (extroverts). They are more energetic. They tend to follow rules closely and like their dogs they are more obedient. Cat people tend to be neurotic, creative, philosophical and nontraditional. They are more introverted, open-minded and sensitive. Cat people also tend to be non-conformist and score higher on intelligence tests than dog people.

Another informal poll by Hunch.com surveyed 200,00 pet owners and matched their responses with lifestyle surveys. They found that dog people are 67% more likely to call animal control if they find stray kittens whereas 21% of cat people are more likely to try to rescue the strays. Although both are equally likely to have a four-year degree, 17% of cat people are likely to have completed a graduate degree. Dog people are 30% more likely to enjoy slapstick humor and impressions. Cat people are 21% more likely to enjoy ironic humor and puns. Both dog and cat people talk to animals of all kinds and both dislike animal-print clothing.

Our lifestyle may dictate our preferences. Cat people are more likely to live alone and in apartments than dog people and dog people are more likely to live in rural areas. Our values may influence our preferences. Cat people are more likely to be atheists than dog people. And interestingly, dog owners tend to skew Republican, while cat owners lean Democrat. What drives us to seek out either a dog or a cat? Dog people are seeking companionship and cat people are seeking affection.

Perhaps you have no interest in pets. Housing, loving, loathing or ignoring a pet is not a definitive statement of your worth as a human being. However, I believe that your treatment of pets indicates a respect or disrespect for life. German philosopher Kant said “We can judge the heart of a man by his treatment of animals.” The abuse of animals is one marker for the mental health disorder psychopathy. Animals can feel pain and suffer, but sociopaths have a general inability to empathize. They are able to inflict pain on animals with no remorse.

But one thing I know about the difference between cat people and dog people, is that cat people miss out on Halloween dog costume contests. Perhaps because dog people are more social, and dogs tend to enjoy social opportunities, they are likely to engage in events such as this.

Rotary Club of Galena is hosting the 1st Annual Canine Contest on Saturday, October 28 from 11:00-1:00. There is a 2 mile dog walk, prizes for best costume and best trick, professional photographers on hand for pet and owner portraits, and hot dogs for lunch. Please join the fun.

 

Would You Know What to Do If Your Friend or Family Member is Experiencing a Psychosis?

I have been trained in CPR to help someone having a heart attack, and I’ve learned how to administer Naloxone (a.k.a. Narcan) to people who are experiencing an opioid overdose. But I had not been taught what to do with someone who is having a psychotic episode. I recently attended a Mental Health First Aid workshop in which we were taught how to identify, understand and respond to signs of mental illnesses and substance abuse disorders. One problem that is most commonly misunderstood is psychosis.

Psychosis is a general term used to describe a mental health problem in which a person has lost some contact with reality. The NIMH (National Institute of Mental Health) defines an episode of psychoses as one in which a person’s thoughts and perceptions are disturbed and the individual may have difficulty understanding what is real and what is not. Symptoms of psychoses include delusions (false beliefs) and hallucinations (seeing or hearing things that others do not see or hear). Other symptoms include incoherent or nonsense speech, and behavior that is inappropriate for the situation. Psychoses may involve delusional beliefs, some of which are paranoid in nature. Signs and symptoms of psychoses vary from person to person and can change over time. People in early stages of a psychosis often go undiagnosed for a year or more before receiving treatment.

Psychoses can occur with a number of mental health disorder such as schizophrenia, bipolar disorder, intense depression or it can be brought on by prescription drugs or illegal substances. It is caused by a combination of factors such as genetics, biochemistry, and stress. Stress and drug abuse may trigger an episode. Early intervention is important. The longer the delay between the onset of psychosis and start of treatment, the less likely the person is to recover.

So, how do you help someone who is in a psychotic episode? Your task is to de-escalate the situation. Mental Health First Aid’s Action Plan utilizes an acronym ALGEE.

Action A: Assess for risk of suicide or harm. There is a very small percentage of people experiencing psychoses who will threaten violence. They are not usually aggressive and are more likely to harm themselves than others. But if it occurs, don’t put yourself in a position of potential harm. Draw them outside or to a place of easy escape.

Action L: Listen nonjudgmentally. Approach them in a caring manner to discuss your concerns and let them know that you are interested in what they are going through. It is best not to try to reason with people having delusions. Don’t confront or criticize. Don’t act alarmed by the person’s delusions or hallucinations, and don’t encourage or inflame their paranoia if they have them.

Action G: Give reassurance and information. Offer support and understanding while conveying a message of hope that there is help available and things can get better. Provide practical help by asking what they need to feel safe and in control. Offer them choices of how you can help. Provide resources that are appropriate to their situation.

Action E: Encourage appropriate professional help. Ask them what they have done in the past that has been helpful. Support them in accessing services.

Action E: Encourage self-help and other support strategies. Friends and family are important resources. A person is less likely to relapse if they have good relationships.

Let’s make Mental Health First Aid as common as CPR. Find a class or become a trainer at https://www.mentalhealthfirstaid.org.

No One Says “I Want to Be a Drug Dealer One Day”

What motivates someone to become a drug dealer? Few people purposefully set out in life to become entrenched in other’s addictions. There are circumstances in which legitimate businesses such as the manufacture and sale of alcohol, and medical marijuana in some states, provide the opportunity for abuse and addiction. In spite of the opportunity for abuse, I wouldn’t call them drug dealers. A drug dealer is an individual who sells drugs, of any type or quantity, illegally. They can be small-time dealers who sell small quantities to offset the costs of their own drug use, or they can be highly organized groups and businessmen within high-organized operations that run like a serious business.

Some people are born into a family of drug dealers. I knew a young man who was sent off to school by his parents at age nine with a backpack filled with illegal substances. He was told to sell them to his peers. By nature (heritable traits) and nurture, his life direction was set to become a drug dealer and eventually, a person who became dependent on heroin. He may have briefly enjoyed high status among his peers. But his future was anything but bright as an adult. He sought treatment for his addition but faced barriers. He has an incomplete education after dropping out of high school. He has a criminal history and felony charges. These prevent him from gaining employment outside the drug world. He is not eligible for federal student loans. He lacks a valid driver’s license and doesn’t have the financial means to own a car. He relies on his family for support but they are elderly and have few resources themselves.

Financial security leads some people into the illegal sale of drugs. The desperation of extreme poverty could cause any of us to act against our morals and engage in illegal activities in order to feed our children and provide housing for them. Or, as previously stated, some people see it as a Wall Street style investment. It is financial opportunity for personal gain.

There is a fine line between being a drug dealer and being a middle-man. Middle men are people who know drug dealers or know of a place to get drugs most of the time. Instead of meeting the drug dealer face to face these middle men can take a person’s money to the place where they acquire the drugs, then deliver the substance back to the buyer. They are still part of a network of illegal activity. It is easy to judge sellers as bad people and users as victims but many people who’ve become addicted to a drug have been in the position of middle man as a means of accessing and paying for their own drugs. The intent is not to make a living by selling drugs, but to help themselves. Middle men may become dealers if the dealers are incarcerated or have died.  They are easily able to do so because as middle men, they know who the addicts are that need the supply and the cycle continues.

In the case of an opioid addict, they become middle men because they need a ready supply of drugs in order to avert withdrawal symptoms. There are also well intentioned enablers who will become middle men. For example, a parent who can’t tolerate seeing their child in pain may either supply the money for drugs, or purchase it for their child. And, people who have experienced the pain of withdrawal may feel compassion for another and help them by supplying or sharing their substances.

What goes on in the mind of a drug dealer? Typically, there is lack of remorse or accountability. “Hey, I didn’t make them take it.” Or, “I’m just the middle man”. Some are thinking of self-preservation. “I have to do this to avoid withdrawal.” The enablers think “I just want to help.” Some people are so desperate that selling drugs is their best option. For example, the benefits of selling drugs outweigh the cost of prostitution, or the cost of not having food for their family. Some drug dealers minimize their role in the crime. “There are so many hands in this business from manufacture, processing, transport, and developing a network, I’m just one more set of hands.”

Interestingly, drug dealers don’t often become rich. They dream of the day they will stop, either through recovery, or living wage work. They want to be respected in the community and earn the praise of their families. These dreams may not come to fruition if they can’t break the cycle of addiction and overcome the barriers brought on by their activities.

Writer Tessie Castillo says that most people make genuine attempts to stop, but are driven to relapse through limited choices, poverty or a system that seems designed for them to fail. “Our attempts to solve the drug problem through capture and punishment often serve to perpetuate the cycle. The great irony of a system that bars someone from employment, education or housing for committing a crime is that it drives people to commit more crimes – selling drugs in particular.” Castillo believes that with strong school systems, living wage jobs and opportunities to become meaningful contributors to society, far fewer people would choose to sell drugs. This is where we should concentrate our efforts – not on building more prisons.

Not All Types of Domestic Violence Are the Same

The vast majority of perpetrators of domestic violence are men. One study in England and Wales showed that 93.9 percent of convicted abusers are male. But it is no less hurtful to a man to be victimized. This is a serious crime that requires legal intervention whether the perpetrator is male or female.

Why are there more male than female batterers? Women are not socialized to dominate in a marriage. Men get societal messages all the time that it’s okay to dominate. More often than not, women don’t have the strength to overpower a man. When asked, most men will admit they are not afraid of their partners. More often a male who is battered is the result of a manipulative event, rather than a pattern of power and control. Women offenders tend to have insight and remorse. They view violence as negative and recognize they have committed a wrong. Whereas, men who batter lack insight and genuine remorse leading to a desire to change.

Not all types of domestic violence are the same. There is battering, resistive violence, and non-battering violence. Most of us know that battering is a pattern of intimidation, coercion and violence as well as other tactics of control to establish and maintain a relationship of dominance over a partner. Few are familiar with resistive violence. This is the use of force in response to another’s coercive and controlling tactics. It is a tactic to either stop or contain the abuse they are experiencing. Typically, a victim tries to stop the abuse through a series of strategies. They start with the use of negotiation, appeals to family and friends, appeasing the batterers, becoming angry themselves, separation, withdrawal, and finally the use of force. Non-battering violence is a third type of violence. It is situational and is not an ongoing pattern to exert control or a response to being controlled. It is violence that may stem from mental health or chemical dependency issues.

Understanding the context of violence is critical. Failing to distinguish one kind of domestic violence from another can endanger victims of ongoing violence. It can result in inappropriate responses by law enforcement, prosecutors and the court, advocates and counselors. It can also embolden perpetrators. For example, the arrest of an individual who committed a violent act on a given day does not necessarily serve justice if they used resistive violence to stop a pattern of battering. They may have used force for self defense, out of fear, self -preservation, to protect kids, or to leave. People will resort to violence if they believe they have no other choice than to be killed. And if they are arrested and wrongfully charged with domestic battering, the batterer may try to use it to further manipulate their victim.

When we learn of acts of domestic violence, let’s not rush to judgment about whom the offender is and who the victim is. Life is often more complicated. In order to better understand the context, we need more information. We need the answers to the following questions:

1. Do you think they will seriously injure or kill you, your children, or someone else close to you? What makes you think so? Do they have access to a gun?

2. How frequently do they assault you? Describe the time you were the most frightened or injured by them.

3. Do they initiate unwanted contact either electronically or in person? Describe the unwanted contact. How often?

4. How frequently do they intimidate or threaten you? Have they intimidated or threatened you regarding talking to the police or seeking help from the court?

5. Have they ever forced you to do things sexually you didn’t want to do?

Police officers gather this information to determine risk of serious harm. They assess whether violence is a pattern of abuse. They try to understand the victim’s perception of risk and level of fear. They gather information on the presence of firearms, threats to kill, prior attempts to strangle, and forced sex. They look for evidence of escalating physical violence over time, stalking, witness intimidation and use of threats against children and pets.

If you are a victim of violence and are ready to seek help, contact the National Domestic Violence Hotline at 800-799-SAFE (7233). There are no fees, no names, no judgment.

Why Doesn’t Our Local Hospital See More Overdose Deaths?

You may be aware of the opioid epidemic in the US right now. Opioids include heroin and prescription pain medication. There are now nearly 100 deaths a day from opioid overdoses. Deaths from opioids have been rising sharply for years, and drug overdoses are projected to increase. The toll could spike to 250 deaths a day, if potent synthetic opioids like fentanyl and carfentanil continue to spread rapidly. It is estimated that the death toll over the next decade could top 650,000.

I wear several different professional hats. One of my hats is that of a substance abuse counselor at Galena Clinic, a drug treatment facility that provides medication to opioid dependent people. We provide Methadone and Suboxone to people who can benefit from its properties. These medications reduce opioid withdrawal symptoms, decrease cravings for opiates, and blocks euphoria if the patient returns to opioid use while taking these medications.

Galena Clinic, located in rural Jo Daviess County, has treated a small handful of people who stopped treatment and later died of an overdose. Our current patients have paid tribute to hundreds of friends or family members who have died, but not necessarily in our small town. We were recently asked by an administrator of our local hospital, why they were not seeing more people in their emergency room who suffer overdoses.

Before I answer this question, I want to contrast our treatment clinic with a clinic in Duluth, Minnesota. I was recently in Duluth for a professional training and had the opportunity to ride along with a K9 police officer on an evening shift that lasted about five hours. Over this time we responded to a complaint of a man who surfed the library computer for pornography; a young woman who had been sexually assaulted and requested a ride home; and we intervened in a domestic dispute resulting in taking a woman to jail on a previous warrant. Additionally, we responded to a very serious domestic situation requiring multiple officers and emergency medical services. We also provided back up for a drug sting operation in which police attempted to arrest a heroin dealer. The dealer escaped but others were arrested. It was a fascinating experience.

While in the officer’s car, I noticed a Narcan kit which is used to reverse opioid overdose. This led to a conversation about the opioid epidemic in Duluth. He had not personally used the kit to rescue a person from overdose. However, he perceived heroin and pain pills to be the top drug of choice in Duluth. When asked if there was a medication assisted treatment clinic in Duluth that offers Methadone or Suboxone, he replied that to his knowledge there was previously a clinic that was shut down. He was of the belief that police were frequently called to the clinic for illegal activity. I asked where the patients were transferred for their medication. He thought they traveled two hours away to access treatment. He told me of a woman who drove back from this distance and got into a car accident, killing two pedestrians. I asked what caused the accident, and he looked surprised at my question, saying “Well, didn’t the Methadone cause the accident?” This indicates a stigma against medication assisted treatment. A stable maintenance dose of methadone does not cause impaired driving. I later learned that there is a closer opioid treatment clinic in the area that patients were transferred.

We made two trips to the Duluth jail to drop off people who were arrested. While there, I asked a female officer if the jail allowed people who were prescribed Methadone or Suboxone to maintain their medication regime while incarcerated. It can’t be fun for the staff to deal with sick inmates. I expected to hear a prohibition against these medications, but I was not expecting intense hostility toward opioid addicts. She said “They got themselves hooked on opiates, they deserve to suffer withdrawal.”

What I gleaned from my ride-along was that Duluth has a strong stigma against medication assisted treatment. The failure of the previous clinic tainted the value of this treatment. The correctional system administers punitive measures towards people who have become dependent on opioids rather than rehabilitative measures. Further, there lacks solid education about this problem and its prevention.

I want to go back to the question of why our local hospital does not have more people seeking emergency help for opiate overdoses. Duluth, Minnesota is quite different from Jo Daviess County.

First, our county is smaller. Duluth is a major port city in the US. Its population of 86,000 is much denser than our rural county of 22,000. Neighboring Dubuque County, Iowa has a population of 97,000 and has a larger overdose death rate. Dubuque hospitals are more likely to see overdose deaths than our Galena hospital.

Second, Jo Daviess County has received Galena Clinic without prejudice. Our staff has experienced the community as kind and generous. Our clinic has received a large donation from the Josh Serpliss Hope Fund of First Presbyterian Church of Galena, Illinois. They chose to name the Fund for Josh Serpliss since he was the son of a pair of members who was going through drug treatment – apparently successfully – but made a fatal decision to go for one last high and died as a result. They donated a large amount of money to provide Narcan to our opioid dependent patients. Our patients have the tools needed in the case of overdose to help themselves without going to the hospital.

Third, Jo Daviess criminal justice system operates along best practice guidelines for opiate dependent people. For instance, the county jail allows Methadone and Suboxone patients to maintain their medication while incarcerated. The majority of US jails do not allow inmates to continue these medications. They require withdrawal from medications which can be dangerous, and which puts the opiate user in jeopardy of overdose death upon their release. And, Jo Daviess Drug Court is open to members who are prescribed Methadone or Suboxone. Unlike some drug courts, they do not require people to withdraw before participating in the program.

Fourth, our clinic follows federal regulations and operates under best practice guidelines. Galena Clinic undergoes numerous reviews from regulating bodies. We have consistently been granted multiyear accreditation. We don’t have complaints of illegal activity that have not been scrutinized. If validated, we take action to prevent illegal or dangerous behaviors. We believe that our treatment clinic is well regarded, thereby reducing stigma against opioid addiction. We provide substance abuse education to the community.

Lastly, there are fewer people experiencing overdose because many of our local opioid addicts are in recovery and we’ve raised awareness in the community. We are proud of the people who have benefitted from treatment and improved their lives as a result of recovery tools.

We would like to express our gratitude to Jo Daviess County for being a welcoming body. Your openness has saved lives. Well done.

Is Extreme Hate a Mental Illness?

Since 1999, the total number of hate groups in the US had more than doubled. There are now more anti-Muslin, anti-immigrant, anti-LGBTQ, white nationalist, neo-Nazi, neo-confederate and black separatist organizations. Although still active, the number of Ku Klux Klan chapters, racist skinhead groups and anti-government militias and political groups have declined. According to the Southern Poverty Law Center, there are 917 hate groups currently operating in the US. What these groups have in common? They share a belief or practice that maligns an entire class of people, typically based on race, gender and religion. As a mental health counselor, I have to ask if extreme hate should be a diagnosable mental illness.

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the psychiatric profession’s index for diagnosing psychiatric symptoms. It does not include racism, prejudice, or bigotry and there is no support for future revisions of the DSM to include it. However, there are associations of these beliefs and behaviors that may fall into other categories of mental illness. Some could make a case that extreme prejudice is a form of a delusional disorder, or is an aspect of a personality disorder. It could also indicate paranoid psychotic disorders such as schizophrenia and bipolar disorders. People with these delusions usually have a serious social dysfunction that impairs their relationships and ability to work. They pose a threat to themselves and others and need treatment.

Not every form of hate is problematic but in its extreme form, it poses a threat to the individual and others. There is a difference between ignorance and hostile aggression. For example, psychologist Gordon Allport, in The Nature of Prejudice, categorizes extreme racists’ violence on a five-point scale of increasingly dangerous acts. “It begins with verbal expression of antagonism, progresses to avoidance of members of disliked groups, then to active discrimination against them, to physical attack, and finally to extermination (lynchings, massacres, genocide).” Allport believes that the acting out of extermination fantasies is a classifiable delusional behavior.

Some might believe that because racism and other forms of extreme hate don’t fall into a clear diagnostic category that it cannot and should not be treated. There are differences of opinion among mental health providers about its classification in the DSM. But everyone agrees that it is a social and cultural problem. It is learned or acquired behavior that is expressed in one’s community and must be stopped. Extreme hatred causes extreme crime.

There are a number of conditions that are not specifically listed in the DSM that are nonetheless a focus of treatment. For example, sex addiction and domestic violence lack a diagnostic label, yet people who perceive themselves to be sex addicts and domestic violence perpetrators may be helped in treatment. The same may potentially be true of haters. We need to increase education in the US about this population. We need to address prevention and intervention strategies. One goal of treatment would be to help the person gain insight into their beliefs that support their hateful actions. The person’s healing could stop the cycle of violence. The Southern Poverty Law Center is a change agent dedicated to fighting hate, teaching tolerance, and seeking justice. They do this by using litigation, education and other forms of advocacy.

Perhaps a psychological diagnosis is not a useful way to view hatred. Some people resist calling it a psychological disorder for fear that it will absolve haters of blame for their hateful actions. They prefer to examine hate in a moral context and call it evil, rather than cloak it in a psychiatric term. Extreme hate can be seen through the lens of social psychology, psycho pathology or morality. In any case, I am comfortable naming it evil.

So what can you do? Start by examining your own prejudices. Take a look at where you fall on the Racism Scale at http://racismscale.weebly.com and examine your own biases. Extend this to examine your gender and religious bias. Next, have these conversations with your family and friends. Extreme hatred is a problem that can be seen as an infectious disease that is plaguing our nation. We need to identify the symptoms, name it, and prevent it from spreading.

What’s the Harm of Social Media on Our Youth?

My great-niece, Amanda, had what appeared to be a falling out with her friend. They had been best friends largely due to proximity. They were neighbors and could talk across the fence. Last year Amanda refused invitations for play. Upon searching for a cause, she admitted that her friend wasn’t fun anymore. Her friend ignored her when they were together because she was on social media or playing on touchscreen devices. It just wasn’t fun for Amanda.

It’s not that Amanda doesn’t have her own tablet for games. In fact, I gave her a Kindle Fire for her third birthday. And I recently gave her my old iPod at nine years old. These were well-intentioned gestures but I already have regrets. Research demonstrates both positive and negative aspects of touchscreen devices but some of the harmful effects cause me to worry.

Everyone knows that children’s use should be monitored and their viewing time should be limited. Computers and other devices should be kept in a public place and children shouldn’t be allowed to take them to bed with them. They shouldn’t even be used as an alarm clock. You should set restrictions so they can’t access adult content.

Psychologist Sue Palmer believes the IPad is a threat to our children. She points to excessive screen time as associated with obesity, sleep disorders, aggression, poor social skills, depression and academic underachievement. Although toddlers become adept at swiping a screen, children’s coordination may lag due to a sedentary lifestyle. Other research has demonstrated beneficial effects such as improving early literacy skills and improving academic engagement in students with autism. The American Academy of Pediatrics recommends a guideline of no screen time for children under two and a maximum of two hours a day thereafter.

There is compelling research that social media contributes to social isolation, rather than social engagement. More time on social media is linked to depression, jealousy, low self-esteem and feelings of inferiority. A study from the University of Pittsburgh found that people who used social media two hours or more a day had twice the odds of feeling socially isolated than people who spent less than half an hour a day. Theories about why this happens is that viewing social media takes away from person to person contact. Or, that we make comparisons to others’ posts and may feel jealous of what appears to be a happier life than ours. One study found that regardless of the number of friends we have on social media, we still only have a small circle of real friends. Some say that real friendships require actual person to person contact. And for children that means just hanging out.

Technology is a wonderful tool and social media itself is not bad. However, children do not have the ego strength to combat cyber-bullying. They take negativity to heart. Without a fully developed brain and maturity, they are vulnerable to aggressive or hurtful words and lack sufficient skills to cope. For children who are still developing social skills and have insecurities, social media may amplify their struggles of feeling left out. Those not invited to join their friend’s activity are keenly aware of it, if their friends post news of the event.

What worries me most for Amanda is research by Jean Twenge which states that teen depression and suicide has skyrocketed since 2011, when IPads and IPhones entered the scene. A 2017 survey of more than 5,000 American teens found that three out of four owned an IPhone. Teens are frequently on their phones, in their room, alone and often may be depressed. “The number of teens who get together with their friends nearly every day dropped by more than 40% between the years 2000 to 2015. Teens who spend more time than average on screen activities are more likely to be unhappy, and those who spend more time than average on non-screen activities are more likely to be happy.”

My advice to Amanda is to use the IPod in moderation, limiting it to under two hours per day. Then put down the device and do something that does not involve a screen. I want her to fill her life with physical activities like sports, outdoor hobbies, or just hanging out with her friends, without a tablet or phone.

Obscenities: What’s the Point?

My nine-year-old great-niece, Amanda, was taught not to use swear words. There is socially acceptable language and then there are “bad words.” She told her grandmother that her four-year-old brother had watched a movie with bad words in it. When asked what the words were, Amanda said they were “S” words. Her grandmother asked what the “S” words were. To her surprise, Amanda said the movie had words like stupid and shut up in it. Her grandmother could think of a number of worse “S” words. Children are taught the difference between respectful language and words that can hurt. Young children haven’t mastered the concept of empathy or socially acceptable words.

What about adults that freely use obscenities? Some people believe that swearing is a sign of a limited vocabulary, a result of a lack of education, laziness or impulsiveness. This theory would believe that when people struggle to find the right words, they fill in the gaps with swear words. Research has demonstrated that this is not the case. Instead, people fill the gaps with “ers” and “ums,” not swear words. Interestingly, researchers found that fluency with taboo words might be a sign of overall verbal fluency or intelligence. They may be more sophisticated in the linguistic resources they can draw from to make their point.

There is a field of research that studies the reasons why we swear. There are distinctions between taboo words that express heightened emotional states (e.g., f*ck), person-directed words (e.g., f*cker) and slurs (e.g., sl*t). Verbally fluent people have the ability to use these words fluently, but they may choose not to. They may have a wider vocabulary to draw from and will express themselves in a socially acceptable way.

Timothy Jay, a professor at the Massachusetts College of Liberal Arts says we use taboo words at a rate of one taboo word per 200 words. This rate differs among age groups. Swearing peaks in adolescence; men swear more often and more offensively; and swearing differs from one individual to the next.

Profanity in some settings is considered inappropriate and unacceptable. It’s usually related to anger, frustration or surprise. But it can also be associated with honesty, being used to express unfiltered feelings and sincerity. Some people appreciate those who “tell it like it is” rather than filter their language to be more acceptable.

I have been known to use cuss words. And although I’m comfortable with taboo words, I am aware that words can hurt. Freedom of speech is a founding principle of a democratic society, but there is also “unprotected speech” where it can be restricted. Slander, libel, and “fighting words” are examples of unprotected speech that are deemed harmful to others.

I’m an advocate for respectful language. I want Amanda, and others, to choose their words carefully in a respectful and socially acceptable manner.