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.

Don’t Take a Squirrel on an Airplane

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Earlier this month a squirrel was denied a flight from Orlando to Cleveland. The owner boarded the airplane with the squirrel in its cage after declaring an emotional support animal on her reservation. The squirrel cleared the x-ray machine. Her mistake was that she hadn’t informed them that her emotional support animal was a squirrel. Once onboard, she was told that squirrels are rodents and are not welcome by Frontier Airlines. The owner refused to get off the plane and everyone was deplaned while police entered. The owner then got off and no further action was necessary. The other passengers made their displeasure known after a two-hour delay. Problems with animals on board have caused many airlines to tighten regulations.

As a psychotherapist, I am called upon to soothe emotions and decrease anxiety. Sometimes a pet can perform the same function. I’ve recently had two people ask me to write a letter stating that their dogs are emotional support animals. More and more emotional support animals are boarding planes. Pigs, peacocks, miniature horses, kangaroos, possums, parrots, ducks, turkeys, lizards, and turtles are boarding planes in addition to cats and dogs. The Air Carrier Access Act prohibits commercial airlines from discriminating against passengers with disabilities. Individual airlines have policies that bar some of these creatures from boarding.

Emotional support animals are companion pets who provide benefit for an individual with a psychological disorder. They differ from service animals, who provide an actual service such as guiding someone who is blind. To fly with an emotional support animal, a passenger needs a letter from a doctor or mental health professional describing the emotional benefit the animal provides for their particular disability.

Our pets become friends and family members. It is with great reluctance that people relocate to a home that won’t allow their fuzzy friend. The Fair Housing Act allows reasonable accommodations be made for people with disabilities. Some people misrepresent themselves as having a disability that only their pet can improve. This behavior makes it more difficult for people with verifiable disabilities to get the accommodations they need.

We all love our pets and find comfort in their presence. In fact, the act of petting can lower blood pressure, help your body release a relaxation hormone, and cut down levels of a stress hormone. Walking a dog is good for the heart. Pets can help you connect with other people. It is easier to strike up a conversation when with a pet. People with pets are generally happier than those without.

I highly recommend that everyone get a pet. Your life will be greatly rewarded. But please follow housing and airline regulations for the comfort of all.

 

 

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Stop Job Shaming

Remember Geoffrey Owens from the Cosby show? He played Elvin, the young doctor who married into the Cosby family. He was photographed while bagging groceries at Trader Joe’s and was caught in an unflattering shot. It represented a downward fall from celebrity for many people. He said he was initially humiliated at being demeaned for doing what he needed to do to make a living and support his family. He then received an onslaught of supportive remarks about the dignity of work.

The woman who took the photo later regretted it. She didn’t intend to job shame him but realized her error after the photo went viral. Owens accepted her apology. This story is an example of job snobbery and classism. All work is valuable and one field of work is not better or worse than another.

Blue-collar and service industry employees often feel judged. White collar professions do not necessarily make one satisfied or produce higher incomes. A Harris Poll found that 86% of blue collar workers said they are satisfied with their job. Blue collar workers are defined as jobs requiring manual labor in construction, manufacturing, transportation and warehousing, automotive services, maintenance, agriculture, forestry, fishing hunting or utilities. Interestingly, less than 1% of actors earn $50,000 or more per year, therefore you will find them in all sorts of careers to pay the bills at home.

There is a distinction between unskilled, semi-skilled and skilled workers. Semi-skilled labor does not require advanced training or specialized skills, but it does require more skills than an unskilled labor job. People who perform semi-skilled labor usually have more than a high-school diploma, but less than a college degree. Psychologist, Dolly Chugh, recommends that we stop using the term “unskilled” workers. Most of the jobs we call “unskilled” are actually highly skilled jobs that require manual dexterity, physical strength, endurance or patience. Negative assumptions are made of “unskilled” workers, contributing to a social hierarchy. We should also stop starting conversations with “What do you do?” and “Where do you work?” Someone’s livelihood does not define them. Being successful has nothing to do with what you do for a living. I’m reading that the US is becoming a “gig economy” in which people generate money from a number of sources. Think of Uber, Lyft, and work from home call centers which allow flexibility and added income.

So, why do we job shame? According to social identity theory, it is human nature to divide groups into “us” and “them.” Our social identity is based on group membership which gives us a sense of pride, self-esteem, and belonging. Sadly, the in-group will discriminate against the out-group to enhance their self-image. We see the group to which we belong as being different from the others, and members of the same group as being more similar than they really are.

Why do we take pleasure in another’s downfall? There’s actually a name for it. Schadenfreude. It is a bit of enjoyment at the misfortunes of others. It is a way to feel better about yourself. People with low self-esteem, or who feel threatened by others, tend to experience schadenfreude more often. People with higher self-esteem don’t need the misfortune of others to feel better.

Are you a job snob? If so, consider your motivation and examine your self-esteem. You might benefit from self-reflection.

Marijuana Addiction is a Real Thing

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No one dies of marijuana use. However, did you know that marijuana addiction is real? It is a disorder that includes physical withdrawal, cravings and psychological dependence similar to other substance addictions. Withdrawal symptoms can include chills, sweats, cravings, insomnia, loss of appetite, nausea, anxiety and irritability.

Have you heard of cannabinoid hyperemesis syndrome? I spoke with a young woman this week who told me she suffers from CHS. She saw her physician for nausea, vomiting, and severe abdominal pain. As he read the symptoms of CHS, she identified with every one of them. She has been unable to cease her marijuana use entirely despite many attempts to do so. She has no doubt that marijuana addiction is real. CHS occurs more frequently among people who smoke 20 or more days per month and multiple times per day.

About 9% of all marijuana users, and 17% of people who start smoking during adolescence, develop an addiction to it. The rate of addiction to marijuana is lower than addiction to other substances. Cocaine and alcohol rates of addiction are 15%, and 24% of people who use heroin become addicted. The process of dependence is slower for marijuana. It may take months or years before symptoms begin to affect a user’s life.

According to the marijuana industry and the federal government, total marijuana use has remained fairly constant over the past ten years despite increased availability.

Marijuana today is not the same as the pot that baby boomers used when they were teens. The potency is increased with genetically engineered plants and the use of concentrated products. Boomers’ pot had THC levels of 2-4%. Nowadays, the average potency is 20% THC and can exceed 30%. Marijuana concentrates and extracts now range from 40-80% THC.

Marijuana use among older Americans ages 55 to 64 is now slightly higher than their children or grandchildren ages 12 to 17. A study from New York University found that more than 20% of marijuana users over age 65 said their doctors recommended they try it for medical reasons. Medical marijuana can be quite different from black market pot found at parties. Eighteen to 25-year-old Americans are decreasing their use of heroin, but their use of methamphetamine and marijuana is up.

As in all addictions, you may suffer from dependency if you are unable to stop your use and if you experience negative consequences from your use. In the case of the young woman with CHS, she could not stop smoking pot in spite of her medical distress, marital and financial problems. Employment drug screens may also pose a threat to a stable life. Help is available.

Be careful.

Does Corporal Punishment Motivate Our Children?

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I never attended a Catholic school but I’ve heard many from my baby boomer friends. Many had been punished by being slapped in the face or hit with rulers when they were young. In fact, one friend told me of being hit in the hands by a nun with a ruler. He can’t recall why he received the punishment. However, he does recall his father taking him in hand back to the school, whereupon he threatened the teachers with a similar fate if they ever hit his son again. Corporal punishment occurs far less frequently now.

Is physical punishment in the school making a come back? Last week, a Christian school, the Georgia School for Innovation and the Classics, asked parents to give the school permission to paddle misbehaving children. Students from kindergarten through ninth grade were sent home with a permission form. The form is alleged to read “A students will be taken into an office behind closed doors. The student will place their hands on their knees or piece of furniture and will be struck on the buttocks with a paddle.” If a parent does not agree to paddling, the child will miss a week of school. One hundred parents returned the form and about one third of them granted their permission to paddle their child.

Let’s define our terms here. Corporal punishment is defined as the use of physical force with the intention of causing a child to experience pain but not injury for the purpose of correction or control of the child’s behavior. The American Academy of Pediatrics considers spanking with an open hand to be acceptable. It becomes unacceptable if it involves use of an object and extends beyond the buttocks, is conducted out of anger, or results in injury.

Corporal punishment was widely utilized in US schools during the 19th and 20th centuries as a way to motivate students to perform better academically and maintain objectively good standards of behavior. As of 2014, a student was hit in a US public school an average of once every 30 seconds. Studies suggest that boys, children of color, and children with disabilities are most likely to be victims of punishment.

The NIH (National Institutes of Health) published an article by Tomoda, et.al. “Reduced Prefrontal Cortical Gray Matter Volume in Young Adults Exposed to Harsh Corporal Punishments.” The bottom line is that frequent and harsh corporal punishment has negative impact to a child’s brain. Physical punishment actually alters the developing brain. They found children who were regularly spanked had less gray matter in certain areas of the brain that have been linked to negative outcomes such as depression, addiction and lower performance on IQ tests. The brain of a child who has been subject to regular spankings is less able to manage their emotions. And if they are less able to manage their emotions, they are more apt to receive harsh corporal punishment.

The American Academy of Pediatrics states “Corporal punishment may affect adversely a student’s self-image and school achievement and that it may contribute to disruptive and violent student behavior. Alternate methods of behavioral management have proved more effective than corporal punishment.” Dr. Robert Sege, a spokesperson for AAP and head of a Child Protection Program said “Corporal punishment is humiliating and is designed to be humiliating and that does not help a child develop their own sense of right and wrong and how they should behave.” Corporal punishment often teaches children that aggression solves problems.

If physical punishment is meant to increase motivation to perform better academically, it misses the mark. In fact, researchers have found a negative correlation between legality of corporal punishment and test scores. Students who are not exposed to school a corporal punishment exhibit better results on the ACT test compared to students in states that allow disciplinary corporal punishment in schools. Furthermore, there is no formal training of teachers in the appropriate use of physical restraints that takes into account the size, age, psychological profile of students, or those who may have existing trauma or mental health issues. The National Association of Secondary School Principals (NASSP) opposes the use of corporal punishment in schools. They cited adverse effects on students’ self-image and school achievement, increased truancy, drop out rates, violence and vandalism. There is also a potential for injury to students and increased legal liability to the schools.

According to Gershoff and Font in a social policy report, “in any other context, the act of an adult hitting another person with a board would be considered assault with a weapon and would be punishable under criminal law.” Why then, would we allow our children to be assaulted?

Just say no to paddling.

How Could I Have Been So Blind?

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As a psychotherapist who specializes in relationship issues, I often see people suffering after relationship breakdowns. They ask “why do I always pick the wrong person?” My standard response is that they are not psychic and they couldn’t have known what this person was like until they’ve spent a good deal of time together. Dating is a period of time to get to know someone before making a commitment. If a commitment is made during an early courtship phase, you may realize that a prince or princess is really a frog when the cloud of infatuation lifts and the rose-colored glasses are removed. Then the question becomes “why didn’t I see these red flags before?”

The truth is, love is somewhat blind for a number of reasons. First, the chemical rush of adrenalin and surge of hormones that come with infatuation causes us to perceive the other as an idealized mate. A hormone called Oxytocin is known as the “cuddle hormone” or the “love hormone,” because it is released when people snuggle up or bond socially. In men, as in women, oxytocin facilitates bonding. When we fall in love, we see them as smarter, prettier, or stronger than anyone else sees them. We are averse to seeing anything that threatens our warm bubble of love.

Second, it is human nature to ignore the obvious. Willful ignorance blinds us to valuable information, facts and behaviors that should alert us. Author, Margaret Heffernan, in her book Willful Blindness: Why We Ignore the Obvious at Our Peril, examines the cognitive mechanisms by which we choose, sometimes consciously but mostly not, to remain unseeing in situations where “we could know, and should know, but don’t know because it makes us feel better not to know.” She argues that the biggest threats and dangers we face are the ones we don’t see. Not because they’re secret or invisible, but because we’re willfully blind. We conveniently filter things that unsettle us.

Third, confirmation bias drives us to believe what we want to believe. We seek confirmation of what we already believe to be true. Confirmation bias is the tendency to search for, interpret, favor, and recall information in a way that confirms one’s preexisting beliefs or hypotheses. The effect is stronger for emotionally charged issues and for deeply entrenched beliefs.

Fourth, sometimes we are in the presence of someone who deliberately seeks to deceive and manipulate. We all like to think of ourselves as pretty sharp, but charlatans exist.

Are we doomed to repeatedly make the same mistakes? No. We can learn from experience.

  • Take your time. Don’t make a life long commitment in the first year and a half of dating.
  • Challenge your thinking. What red flags do you see?
  • Seek feedback from others. Others may see what you are blind to.
  • Love is an emotion, not a fact. Gather and verify information as you get to know someone new.
  • Don’t be too hard on yourself. It is human nature to seek and preserve love.

End of Life Decisions

I’m sad to hear news that Senator John McCain passed away at the age of 81. He was diagnosed with brain cancer last year. He spent the final months of his life out of the public eye, reflecting on the meaning of his life and accepting visitors. He planned his own funeral services. Senator McCain made a decision to discontinue medical treatment on August 24, 2018 and died the next day in his home surrounded by his family.

Senator McCain had a rich, satisfying and meaningful life. In a memoir published in May, Senator McCain wrote that he hated to leave the world, but had no complaints. “It’s been quite a ride. I’ve known great passions, seen amazing wonders, fought in a war, and helped make peace. I’ve lived very well and I’ve been deprived of all comforts. I’ve been as lonely as a person can be and I’ve enjoyed the company of heroes. I’ve suffered the deepest despair and experienced the highest exultation. I made a small place for myself in the story of America and the history of my times.” He bravely made a decision to stop life-sustaining treatment.

How does one come to a decision to discontinue medical treatment, knowing that it will hasten death?

The right to refuse end-of-life care was guaranteed to Americans in 1991 with the passage of the federal Patient Self-Determination Act (PSDA). It guaranteed that Americans could choose to refuse life-sustaining treatment at the end of life.

When you choose not to receive aggressive medical treatment, you are generally choosing what you believe will be a better quality of life, rather than a longer life that may be less pleasant. You have decided to stop futile, unnecessary or invasive treatment that may harm more than help.

You are still entitled to palliative care, which can be administered to people who don’t want to be kept alive. Palliative care focuses on relieving pain at the end of life but does not extend life. You continue to receive medical treatment that is aimed at comfort care, not cure, designed to treat pain and suffering.

When to stop aggressive cancer treatment is a very difficult decision. Many believe that cancer patients should not be subject to harsh and painful treatment. Yet, three out of four cancer patients in their last month of life, under the age of 65, received aggressive treatment and only a handful got comfort-based hospice care instead. Dr. Otis Brawley, the American Cancer Society’s chief medical officer said “there are hundreds, if not thousands, who undergo too much therapy and too much suffering for every one person that we have who ends up having a miracle.”

Are people who choose to stop medical treatment just giving up? No. You’re not giving up if you don’t do treatment. You’re still fighting for your life, in a different way. You’re fighting to have good, purposeful, meaningful days. It is a patient’s right to make these decisions for themselves.

It is a reality that some patients are unable to make this decision. They may lack sufficient knowledge regarding their condition. Or, their condition may involve cognitive impairment. Ideally, this decision is based upon information about the patient’s clinical state and circumstances, the available research evidence as well as patient’s values and preferences, including their preference regarding their role in decision making. Some people prefer that others make a decision for them.

It can be overwhelming to make healthcare decisions for someone who is dying and are unable to make their own decisions. Even when you have written documents, the documents may not cover every situation that arises. According to the National Institute of Aging (NIA), two approaches are useful. First, put yourself in their place and try to choose as they would choose. This is called “substituted judgment”. Second, is to decide what would be in the best interests of the dying person. This is known as “best interests”. If possible, combine both approaches.

NIA also recommends that if you are making decisions for someone at the end of life and are trying to use one of these approaches, it may be helpful to think about the following questions:

  • Has the dying person ever talked about what he or she would want at the end of life?
  • Has he or she expressed an opinion about how someone else was being treated?
  • What were his or her values in life? What gave meaning to life? Maybe it was being close to family—watching them grow and making memories together. Perhaps just being alive was the most important thing.

If you are struggling with end-of-life decisions, I strongly recommend you read Understanding Healthcare Decisions at the End of Life at nia.nih.gov. This guide includes questions to ask your doctor and medical staff, practical advice on issues you may face, family involvement, working with medical staff and more.

Human Trafficking Occurs in Our Neighborhoods

You wouldn’t think that human trafficking happens in your own neighborhood, but it happens everywhere. Galena Rotary Club invited Toni Lucas to speak to our members about human trafficking this week. Ms. Lucas is the chairperson of Rotary District 6420 Task Force Against Human Trafficking. I was surprised to hear that Illinois ranked number 10 in the US for trafficking in 2017. Nearby Rockford, Illinois was ranked second in the state for human trafficking in 2015. I’m grateful to Rotarian Toni Lucas for educating us about this important issue. The statistics in this article are adapted from her presentation.

So what is human trafficking? Labor trafficking is force, fraud, or coercion used to induce a person for labor or services in involuntary servitude, debt bondage, or slavery. Sex trafficking is a commercial sex act that is induced by force, fraud, or coercion.

Who are the victims? Trafficking victims can be any gender, age, race, nationality. In the United States, it happens in all 50 States and in cities, suburbs, and rural areas. Individuals who are at risk include people with limited social safety nets, homeless and runaway youth. Or, people who are undocumented or have illegal immigration status, or those with limited English proficiency. However, anyone can become a victim.

The International Labor Organization estimates that there are 40.3 million victims of human trafficking globally. 81% of them are trapped in forced labor. 25% of them are children. 75% are female. The International Labor Organization estimates that forced labor and human trafficking is a $150 billion industry worldwide. In fact, the highest days for human trafficking in the US are Super Bowl, Indy 500, and the Kentucky Derby. I will never view these events again without thinking of victims of trafficking.

Here’s what to look for. You might notice that someone is not free to come and go as they wish. They don’t have money even though they work a lot. They owe a large debt and are unable to pay it off. They were recruited through false promises. They don’t have access to their passport or other documentation. There is evidence they are being controlled. They may have a tattoo with the name of a trafficker. They may live with co-workers or their “employer” or there may be secrecy about their whereabouts. For more signs of trafficking perpetrators, refer to the Duluth Model Sex and Labor Trafficking Power and Control Wheel at https://humantraffickinghotline.org/sites/default/files/HT%20Power%26Control%20Wheel%20NEW.pdf

Victims can’t escape their situation easily. They might be unaware that what is being done to them is a crime. They may have developed positive feelings or loyalty toward the trafficker. They may fear or distrust law enforcement or social service providers. Many fear for own safety or that of family members or have lack of options. There could easily be fear of deportation or arrest. They may feel shame or fear of what they will face if they come forward.

President Obama made the following remarks to the Clinton Global Initiative on September 25, 2012. “It ought to concern every person, because it is a debasement of our common humanity. It ought to concern every community, because it tears at our social fabric. It ought to concern every business, because it distorts markets. It ought to concern every nation, because it endangers public health and fuels violence and organized crime. I’m talking about the injustice, the outrage, of human trafficking, which must be called by its true name — modern slavery.”

If you suspect human trafficking, call 888-373-7888 to reach the National Human Trafficking Resource Center.

What Do You Say at the Funeral of Someone Who Struggled with Opioid Addiction?

I’m reading a Chicago Sun-Times column entitled “What I’ll Tell My Kids Someday About Drug-Addicted Uncle They Never Knew.” Author Stefano Esposito’s brother, James, died in a car accident at age 28. Stefano’s sons are ages six and one. He wonders how he will describe his brother’s death to them when they are older.

James’ death was caused by a collision into a concrete embankment. Stefano believes the accident was influenced, or perhaps caused, by James’ substance abuse. James had a history of heroin abuse. It sounds as if James made a good effort to stop his opiate addiction. He relocated out of state to start a new life, without easy access to drugs. We can’t know by the news story if James had found sobriety. However, the implication is that he had relapsed because he was in contact with his ex-girlfriend and that another presumed drug addict attended the funeral.

James was described as a sweet kid who made friends easily. He was well loved. At the funeral their mother said trembling “He was my son, and I loved him.” Stefano will tell his sons that he loved James, but wonders whether he could have done more to help him. He is angry for the pain James caused. He is also angry that his brother will not be available to help Stefano when he grieves their mother’s death. Stefano will tell his sons that James never met him, never hugged them, and would never know the joys of being a father because of drug addiction. Stefano’s greatest fear is that drugs will take his son’s lives.

Could Stefano have done more to help him? I don’t have knowledge of what efforts were made. I do know that he can do more to honor James’ memory.

So, what could Stefano say of his brother’s death? I would encourage Stefano to say that his brother was a wonderful young man. I’d recommend that Stefano tell the stories they shared as brothers, as is common in a celebration of one’s life. I would say that he was not only sweet, but resourceful, brave and motivated for change. James went to great lengths to find sobriety by moving out of state where he presumably had few friends or family.

I would recommend that he tell his sons that James had a disease, not unlike other diseases like diabetes or cancer. I would explain the nature of addictions and describe an automatic feedback loop in his brain that causes cravings for more drugs, against his better judgment. In fact, addiction impairs judgment, memory and reasoning skills. I would tell them that there are medications to treat opioid addictions, like Methadone and Suboxone. When coupled with counseling, countless people find sobriety.

I would educate his sons on opioids, which include heroin, as a class of drugs that are different from other substances. Other substances, such as cocaine and methamphetamine, are easier to stop. Those drugs are primarily psychologically addictive, whereas opiates are physically addictive. Withdrawal from opiates can be so severe that the user will do just about anything to avoid the symptoms. I would explain the swift progression of opiate dependence, in that someone can quickly become addicted from medically prescribed pain killers. I would tell them that if a patient is abruptly cut off from their prescription, they may turn to heroin which is cheaper and easier to access.

I would tell the story of the expansion of opiate use in the US when drug manufacturers heavily marketed pain killers to the medical system, falsely claiming that they are not addictive. I would say that 115 people a day are dying of an opioid overdose, partly due to this false misrepresentation.

I would talk about sadness over the loss but I would not be quick to express anger. No one sets out to become addicted. I would also tell his sons that sometimes accidents are just accidents, and correlation is not causation, and we’ll never really know what happened to cause James’ death.

I would ameliorate the stigma of addiction and celebrate a life that was more than one dimension. There was much, much more to this young man than a substance abuse problem. He deserves the same respect at death as one who dies of diabetes or cancer.

I would talk about James’ death with love and respect and utilize it as a learning tool for his sons.

Divorce: Fault or No Fault?

I was surprised to read of a woman in England who was denied a divorce by the Supreme Court. She sought a divorce after 40 years of marriage at age 68. Her 80-year-old husband refused the divorce. She must remain married until 2020, after having lived apart for at least five years. At that time the divorce is granted, even if your spouse disagrees. A Parliament judge stated that being in a “wretchedly unhappy marriage” was not a ground for divorce.

Grounds for divorce in England and Wales are subject to a “fault-based” finding. You must prove that your marriage has broken down irretrievably and cite one of the following reasons; adultery, unreasonable behavior, desertion, you have lived apart for more than two years and both agree to the divorce, or you have lived apart for at least five years, even if your partner contests it.

At-fault divorces may create unnecessary antagonism in an already emotional situation. In England and Wales 70% of couples said that using fault made the process more “bitter”; twenty-one percent said it made it harder to sort out arrangements for children; thirty-one percent said it made it harder to sort out finances; sixty percent of divorces used fault-based grounds. A law professor in Scotland believes that “the judicial system doesn’t have time to question the allegations or demand any real proof, meaning that accusations go unquestioned, even if the accused deny they have behaved unreasonably or had an affair.” This leads to manipulation of the system.

This story made the news headlines in the U.S. perhaps because this is a surprise to Americans. Every U.S. state offers the option of no-fault divorce in which they are not required to show wrongdoing by either party. In many states, no-fault is the only option. California was the first US state to pass a no-fault divorce law. New York was the last state to pass it. Prior to no-fault divorces, there was an adversarial system, demonstrating the fault of one, and only one, party. Traditional fault grounds are cruelty, adultery, desertion, confinement in prison, and a physical inability to engage in sexual intercourse, if it was not disclosed before marriage. One study showed that domestic violence and female suicides declined in states that legalize no-fault divorce. One spouse cannot stop a no-fault divorce.

In Illinois, a divorce can be based on either fault, or no-fault grounds. Reasons that one might claim at-fault grounds are to gain an advantage in child custody cases or a dispute about division of property. For more information, see Nolo’s Essential Guide to Divorce by Emily Doskow.

Some believe that a no-fault divorce system undermines the institution of marriage. This may be from religious beliefs, or from civic arguments that our society is damaged from failed marriages. They prefer a long waiting period before a divorce is granted. It allows couples to change their minds and helps a person who does not agree to the divorce make adjustments to this profound and life-changing event.

Divorces that are kinder serve both parties as well the children. If you cannot remain married, the best thing you can do for yourself and your family is to take the high road whenever possible. This means trying to compromise, consider your partner’s feelings, seek to negotiate a solution that works for everyone, not just you. Don’t create or escalate conflict. Although this is not always possible, you will feel better about your handling of this painful event.

Opioid Overdose Epidemic is Getting Worse

Just when you thought the opioid overdose epidemic couldn’t get any worse, it has. It spread. Now, more people are dying of fentanyl laced methamphetamine and cocaine.

Deaths in Philadelphia involving cocaine and methamphetamine are increasing in combination with fentanyl. According to a study by the Philadelphia Department of Public Health From 2016 to 2017, the number of cocaine deaths involving fentanyl increased by more than 130%, and the number of methamphetamine deaths involving fentanyl increased by more than 200%. It has spread to other states.

Fentanyl is a prescription opioid painkiller. It’s primary use is as an adjunct to anethsia. It is a narcotic painkiller that is up to 50 times more potent than heroin and up to 100 times stronger than morphine. It is used to treat severe pain such as in patients who have terminal cancer. A euphoric high or death can occur if a person takes too much of it. Many overdose deaths are caused by unknowingly ingesting this drug with what they think is heroin.

Methamphetamine is referred to as “meth.” It is a stimulant. Meth is often confused with Methadone. Say it out loud, “Meth is not the same as Methadone” and commit it to memory. Meth is an illicit substance of abuse. Methadone is a helpful medication to treat opioid addiction.

Meth can cause hallucinations and violent behavior and take a toll on medical health. Meth surged in the 2000’s because it was easy to produce in labs set up in homes or abandoned buildings. Congress cracked down on the sale of Sudafed, used in cooking meth, by requiring a prescription. Much of the meth comes from Mexico now, rather than being produced locally. It is popular, plentiful and more lethal than ever. Although it is harder to overdose on meth than opioids, meth related overdose deaths are increasing. Both meth and heroin can cause heart failure.

Cocaine is a stimulant known as a party drug. Fentanyl-laced cocaine can be a deadly drug mixture. The DEA reports 7 percent of cocaine seized in New England in 2017 included fentanyl, which is a 4 percent increase from 2016. And in Connecticut, the number of fatal overdoses involving cocaine and fentanyl together has increased 420 percent in the past three years. Law enforcement officials speculate that dealers are adding fentanyl to cocaine because it is more cost-effective for them, and it makes the drug more addictive.

The gold standard of opioid dependence treatment is Methadone, Buprenorphine (a.k.a. Suboxone), and Naltrexone (a.k.a. Vivitrol). The properties of these medications are threefold. First, Methadone and Suboxone stop withdrawal symptoms. Second, when on a therapeutic dose, these medications block euphoria. Third, they reduce cravings.

There is no equivalent medication for meth or cocaine. Non-opioid substances are primarily psychological in nature, whereas opiates are biologically and psychologically addictive. Therefore, opiate addicts can undergo severe and intense withdrawal symptoms when the opioids are ceased. People in late stage opioid addiction are no longer getting high. They are simply trying to avoid withdrawal symptoms. They may turn to meth or cocaine to get through the sickness.

While we’ve been watching one epidemic, another has sprouted. Rather than say that we have an opioid epidemic, we should now admit we have a polysubstance problem.

What can we do? This is a complicated and multifaceted problem. But one thing that can help is Naltrexone (a.k.a. Narcan) that reverses an opioid overdose. It is effective to combat fentanyl that is mixed with other substances. Naloxone is available from many pharmacies now. Treatment providers should be ready for this new, potent, and deadly wave of addiction. If you or someone you know takes these substances, be careful.