Clinically Speaking is a blog that will allow anyone to learn about Social Work, case presentations in psychotherapy, and the relationship of pop culture in psychology. Come one...come all!!!

Thursday, March 29, 2012

Addiction Treatment

We are all very aware of the various group therapy treatments, such as NA, AA, GA, SA. Pretty much any "A" you can find, you can become treated. There has been a lot of emphases on treating addictions with medication, as we had spoken about previously, most addictions are organic and since there is a physiological aspect to it from the addiction side, a way to treat has been through medication. Recently, there has been a big push in using Buprenorphine. Which has become the leader in treating: opiate, dependency, detoxification from heroin, oxycodone, hydrocodone, morphine, oxymorphone, fentanyl or other opioids. A big reason in using this specific drug is the low risk it has accompanied with becoming addictive. Furthermore, we know from TV/Movies that depending on the addiction, people do need "detox" themselves in order to "hit the restart button" on their body. Since I am therapist by profession, today's post will focus on the therapy aspects rather than the medical aspects of treatment. 

E-Therapy VS. Face-to-Face Therapy
In the 2011, American Journal of Drug and Alcohol Abuse, there was a study conducted that examined the uses of internet/electronic based therapy versus the conventional office/face-to-face therapy. The article explained that e-therapy would be a better modality than face-to-face therapy as reported that "in the United States, only 16% of people with an alcohol-abuse disorder had received treatment in 2001." As a side note, I personally believe this is not specific to substance abuse, but rather all mental health due to the unfortunate stigma that still remains. The results concluded that "We can conclude that the e-therapy program successfully attracted clients who were different from those who were represented in regular face-to-face alcohol treatment services. This indicates that e-therapy decreases the barriers to treatment facilities and enhances the accessibility. The e-therapy program reaches client groups that are still difficult to reach in regular face-to-face therapy. However, we saw that the e-therapy population changed over time. In 2005–2006, the e-therapy program really reached a new population of problem drinkers. Although the e-therapy program still did reach an important new group of clients in 2008–2009, this group showed more overlap with the traditional face-to-face group of clients: less employed clients and less first time treatment seekers.(Marloes G. Postel, M.Sc.1,2, Hein A. de Haan, M.D.1,2, Elke D. ter Huurne, M.Sc.1, Eni S. Becker, Ph.D.3, and Cor A. J. de Jong, M.D., Ph.D.2)

Thought that was pretty interesting...might be a topic for an upcoming post, the idea of e-therapy and its place.

Assesment Tools
There are many preventative measures that are used within the field of therapy and substance abuse, I can tell you when I see my patients I use the MSSI-SA. Which stands for Modified Simple Screening Instrument for Substance Abuse (MSSI-SA) Self-Administered Form. This is used primarily for settings that do not specialize in substance abuse treatment, yet it gives an idea if the patient is or can become at risk to substance abuse.

One more day...till Friday hang in!!

Tuesday, March 27, 2012

Genetics, Chemical Imbalances and Addiction

Today we will examine the role genetics play in addiction. We are all aware that genetics do play a role when it comes to addictions. We know that if a parent or uncle or grandparent was an addict the risks of you becoming an addict are highly elevated. If you are interested in the statistics click the link to addictions and recovery here. It does a great job breaking it down for you. In my research for addictions week, I came across an interesting study that was reported on, that has shown a possible link in gender. Dr. Scott Stoltenberg, an assistant professor in the Psychology Department, found links between impulsivity and a rarely researched gene called NRXN3. The newly discovered connection, which was more prevalent among men than women in the study, may help explain certain inclinations toward alcohol or drug dependence.* I think that is pretty cool. Makes you wonder, if the beer companies know that little piece of info? 

I'd like to raise a question, the aforementioned is very interesting and well known and documented, but that is talking about organic addictions. Meaning chemical dependence to a specific drug or alcohol. Those addictions can be explained very easily, no? Body needs alcohol physically, or body needs heroine physically, I get that totally, but does your body chemically need to gamble? Does a person who is has a gambling addiction, is their body saying "I need to go to Vegas and play craps all night or I am going to go into withdrawal" or does someone who has an internet addiction, their body says "I have to watch one more Youtube video or check Facebook or I don't think I'll make it"? 

If you answered no to the gambling question I posed in the previous paragraph, well you would be wrong! Christine Hse of wrote an article called, A Brain Chemical That May Cause Gambling Addiction, or Bankruptcy. She reported that "experts explained that although most people would only enter a two outcome gamble if there was more of a possibility to win more than they could lose, and people with lower levels of norepinephrine transporters and higher levels of norepinephrine showed reduced sensitivity to financial loss, and therefore were more prone to impaired decision making(i.e. gamblers)".  In simple terms gambling addiction may be caused by something actually chemical that is going on in the brain previous to starting to gamble.

If you answered no to the internet addiction question, sadly for would be wrong again! Within the last year, researchers over at MIT and the University of Milan conducted a study that found reason that there is a chemical addiction to Facebook. The study concluded that "Statistical analysis of the psychophysiological data and pupil dilation indicates that the Facebook experience was significantly different from stress and relaxation on many linear and spectral indices of somatic activity. Moreover, the biological signals revealed that Facebook use can evoke a psychophysiological state characterized by high positive valence and high arousal."** Furthermore, Researchers at the Chinese Academy of Sciences in Wuhan published an atrticle called, Abnormal White Matter Integrity in Adolescents with Internet Addiction Disorder: A Tract-Based Spatial Statistics Study, in which the brains of Internet addicts may undergo chemical changes similar to those of alcoholics and other drug addicts.***

Really fascinating stuff...I personally was skeptical about gambling and internet addictions being a chemical imbalance, I blog corrected!

Happy "is winter back in the northeast?" Tuesday!
***Internet Addiction

Monday, March 26, 2012

What is an addiction?

We often hear, "I am so addicted to this TV show, or this ice cream". We don't stop and think about what an addiction really is and how it happens. Lets first start with the definition of an Addict: A person who is addicted to a particular substance, typically an illegal drug. It is important to note that within the definition, the word addicted is used. As we have learned in the past, when a person is being Dx(Diagnoses/Diagnosed), according the DSM-TR-IV every Dx needs to fulfill criteria. The section on substance abuse is very large because it encompasses a lot of different substances which ranges from alcohol to both legal and illegal drugs. I believe and don't quote me on this, that the DSM-V will have sex addictions, internet addiction, and gambling addictions included in some capacity(we will talk about the differences later on in the week). According to the World Health Organization an estimated 76.3 million people struggle with alcohol use disorders contributing to 1.8 million deaths per year. Furthermore, the United Nations reported that around 185 million people globally over the age of 15 were consuming drugs by the end of the 20th century.

Typically, in the mental health field and substance abuse programs, the way we classify an addiction is different then how it is defined. We are able to distinguish the difference by assessing one major factor. If the particular substance or act does not interrupt a person from their daily living, we assume that it is not an addiction, rather a habit. Meaning if someone can go to work, school, attend to his familial and legal obligations of a person in society and is using a particular substance then we say its not an addiction(Btw-that's how the DSM starts the criteria)

But does that make any sense at all? Because I function, that means I am not an addict? This is exactly what a lot of addicts say to rationalize to themselves and others to dispel the notion that they have a serious problem. Now, there is a concept of a functional addict. However, maybe to the rest of the world they seem functional, but in no shape or form are a functional person. An interesting article by Sarah Allen Benton, M.S., L.M.H.C. entitled The High-Functioning Alcoholic, she details the what I had written about functioning abusers.

This is just a little taste of what we will talk about throughout the week.

Tomorrow: Addictions-Are they all chemical?

Don't make your Monday, Mundane!

Addictions Week

This week on the blog will be all about addictions: Treatment, pathology around those who are plagued with addictions, the differences between the addictions, and an interview with a substance abuse therapist.

Stay tuned...should be a good week of knowledge...


Wednesday, March 21, 2012

Resiliency: Nurture or Nature? Part Two

Did you miss me?

Sorry for being MIA, but we are back in action. In part one of this topic we saw in a longitudinal study that perhaps resiliency may very well have a lot to do with something innate rather than a learned behavior. In part two of this topic we will learn that, that thinking may not be so true.

Everything that children do, they learn it from somewhere, children or even adults for the most part don't make behaviors up. It is well documented that children really bring true meaning to "monkey see, monkey do" idea. In regards to mental health that remains true as well. Those of whom that are victims of domestic violence are at high risk to become batterers themselves. According to,  "Boys who witness domestic violence are more likely to batter their female partners as adults than boys raised in nonviolent homes. Of the children who witness domestic abuse, 60% of the boys eventually become batterers." Again "monkey see, monkey do".

In regards to resiliency, I read a journal article by Dr. Steven J. Condly entitled, Resilience in Children: A Review of Literature with Implications For Education. The articles' main theme is about how to understand a child and how resiliency reflects how well they do in school. He writes referencing Norman Garmezy who was the leader in the field of resiliency, lists three factors that may lead to resiliency "(1)native intelligence and temperament...(2)family and degree of support...(3)external support from persons and institutions outside the individual and family." It appears that according to Condly and Garmezy resiliency may not only be innate but heavily on external and environmental factors that help foster resiliency.

Score: Nature-1, Nurture-1

Bottom line: It's a tie. It's a tie because much like everything in life there is not one way to do things to be successful there are specific ways that will facilitate an outcome, but you could get to that outcome in many ways.

Have a Wacky Wednesday!!

Friday, March 16, 2012

Suicide rate surpass combat fatalities in Veterans.

Here is an article that could be an addendum to the posts related to our veterans and PTSD. This article talks about the unfortunate rise in suicides with our veterans coming home from Iraq and Afghanistan.(Hattip AH). Click for here the article Suicides, Mental Health Woes Soar Since Start of Iraq War, Study Finds.

Additionally, I added a three videos, Video One: Echos the article above, Video Two: A really interesting short film about a veteran and suicide. Video Three: Current PSA and suicides with our vets.

Video One:
Video Two:
Video Three:

Hope you have a good weekend!!!!

Thursday, March 15, 2012

Resiliency: Nature or Nurture? Part One

I have always thought about when tough situations arise, are people able to deal them because of an innate trait or learned habit?  Hence the question: Resiliency Nature or Nuture? 

In a study done in 1955, by researchers Emmy Werner (University of California, Davis) and Ruth Smith (licensed psychologist, Kauai) began a longitudinal study that followed all of the children born on the island of Kauai during that year. The studied showed that "found that there were a percentage of children in their sample that faced very adverse conditions as they grew: perinatal stress, chronic poverty, parents who had not graduated from high school, and family environments that were engulfed in the chronic discord of parental alcoholism or mental illness. Many of these children developed serious problems of their own by age 10. However, to the researchers’ surprise, about one-third of the children in adverse situations did very well in their lives. Werner and Smith called them the "vulnerable, but invincible.

Werner and Smith continued the study with the participants until the age of 40 and it revealed that "even more of the high-risk children began to do better as they got older. Werner and Smith found that many of the cohort who experienced difficulties when they were teenagers – delinquencies, mental health problems, pregnancies – had become successful, functioning adults by the time they reached their third and fourth decades."**

It appeared from the research that these participants were not involved with any known psychotherapy to help them guide through these difficult times. 

Score: Nature-1, Nurture-0

Stay tuned for Part Two!

**That quote was from a article on Click for full article called, Learning From Resilient Kids.

Have a splendid madness of a day!(Thursday)

Illusions to help sports athletes

Here is a quick article that may give some explanation when athletes say "everything slows down when I am playing now".  Check out this article, Illusions may improve athletic performance.

Later on Ill talk about resiliency in children.

Happy March Madness!!!

Wednesday, March 14, 2012

Antipsychotics apparently aren't just for psychotics, sadly!

I was sent an article from the Washington Post by a friend of mine who is a therapist in NJ. The article is called Antipsychotic drugs grow more popular for patients without mental illness, click to read in full. Before I read the article I assumed it was going to tell me about how they are being prescribed to help treat behavioral problems in adolescences , which is terrible in itself, but it gets worse as I read on. It appears that psychiatrists and primary care physicians have been prescribing it for sleep apnea, ADHD, and dementia patients. Giving an anti-psychotic to people who have dementia, is not new to the world of psychiatry and psychology, but sleep apnea? ADHD? For ADHD, that means you are prescribing a powerful dose of medication to a child....really? You think this is bad...the worse is yet. I continued to read, and who else is being prescribed anti-psychotics? BABIES!!! Yup, that's not a typo, babies! In the article a pediatrician had reported that he had seen an 18 month old baby being prescribed an anti-psychotic, and early in the article it had been reported that nursing home aides and facilities have been given the residents these medications as well those of whom that do not have mental illness. The reason that these babies and residents were given these medications were to sedate them. hey mom, dad, try being parents and not throwing pills at them to solve the problem, better yet, physicians there is a reason why you train, use what you learn!

A good reason for the misuse of these medications had little to do with actual treatment and a lot to do with medication companies. It is a multi-billion dollar a year industry for psychotropic drugs alone. I will spare you all the percentages and numbers of how psychotropic medication have increased in the last 5-10 years, that could be due to the increase in population seeking mental health treatment which is a good thing, or it could be for the idiotic and irresponsible practices of prescribers and the medication companies whom often give a "kick back" to psychiatrists and PCP's who use their medications. 


Sorry to yell...but its appalling!
Happy Hump day!

Monday, March 12, 2012

We have arrived...on Facebook.

Check us out!!! On Facebook. Check out the page. Search for ClinicicallySpeaking. and Like us! comment and message us!!!
Come on everyone!!


Reality it actually reality?

We all watch some form of reality TV, yes guys we watch reality TV we don't call it reality TV we call it....Sports. Over the last decade reality TV has dominated the airwaves. Whether it be American Idol, The Voice, Survivor(yes, that's still on), Top Chef, Project Runway(yes, I watch that, c'mon Heidi Klum is host) Jersey Shore(Ugh!), NFL, NBA, NHL, MLB all forms of it. We become enthralled with the lives of these celebrities because for some reason we enjoy it. We enjoy the drama queens, the drama kings, we read blogs and entertainment magazines to see where these people are when they are not on TV but still in reality. Why? Why do we like this? Are the lives of these people more realistic then say our own lives? Is it more of a representation of reality?

I don't think it its about the fact that we like to delve into other people's lives and business(although we probably do) I think in a way all the different reality shows have some sort of sentiment of reality themes. We all don't play professional sports, and we all don't compete for a competition formerly. However, we all have this competitiveness aspect in our lives. It could be at work when there is a promotion and they will only promote within the company or agency, or trying get married, in dating there is an aspect of making sure you are desirable enough to date or vying for a person whom you want to date. Dr. Steven Reiss and Dr. James Wiltz, professors of psychology at Ohio State University say in their article, Why America Loves Reality TV, that while they agree that people enjoy reality TV for the competitive nature they add that "Reality TV allows Americans to fantasize about gaining status through automatic fame...Ordinary people can watch the shows, see people like themselves and imagine that they too could become celebrities." That makes me think about another question why do we want to be famous? I don't think its the idea of being famous, its the illusion that if your famous, you have no problems and everyone loves you. In reality(pardon the pun), I do not think that's the way it is. Everyone has their own trials and tribulation regardless of stature or status and feeling good about themselves. Being famous does not equate to high levels of self-esteem. Self-esteem comes from array of different innate and environmental features.

While there are some meaningful lessons that  you can learn from reality TV, remember everywhere you look is reality...find the meaning there!

Happy Happy Monday!

Monday, March 5, 2012

PTSD and Veterans: Part Two

In the previous post, we spoke less about the illness and the patients and more about the services delivery problems. This post we will discuss 3 treatment options for veterans with PTSD. 

Virtual Reality Therapy
Sounds cool right? Believe it or not it is not just about watching a video game. In a column, written by Lisa Collier Cool called,  Virtual Reality Therapy for Veterans with PTSD for She reported that according to Barbara Rothbaum, Ph.D., ANPP, the study’s principal investigator at Emory University said that, "although the traumatic memories will never go away, we believe that virtual reality exposure therapy and DCS( drug d-cycloserine (DCS) to treat PTSD) will make it easier for patients to cope with these memories. This new way of treating PTSD with veterans is a derivative of cognitive behavioral therapy that are the main techniques in treating anxiety disorders(as we know from Psychology 101 post that PTSD is a type of anxiety disorder). Oddly enough, I recently I read an article in GQ magazine that Virtual Reality was not only helpful for victims who have PTSD, but also for those veterans who have had severe burns from war. Burn Victim treated with Virtual Reality .Click for complete story(Hattip AB). Pretty darn cool if you ask me!

Imagery Rescripting and Exposure Therapy 
In the 2011 Journal of Anxiety Disorders there was an article written called, Imagery Rescripting and Exposure group treatment of PTSD**, which conducted research in trying to help veteran who have a Dx PTSD and reduce symptoms and increase sleep patterns. The idea behind Imagery Rescripting when coming to patient with PTSD is that they would rescript the nightmares they were having and/or write out the nightmares they were experiencing in order to attain habituation to the nightmares they were having. In other words, so they could become desensitize to the nightmares and help themselves understand that they are not in any immediate danger and that will allow themselves to relax. This would also help them increase the number of hours they slept, since going to sleep was worse than being always tired and sleep deprived. The study did show that this help increase sleep as well as decrease nightmares. Also really cool!

Group Therapy
Conversely to the two approaches above,  group therapy is not new and in some areas may be the most effective way to treat certain types of disorders. We know from substance abuse treatment from AA to NA those are solely based on group therapy techniques. A good reason for group therapy to work with veterans who have PTSD is the idea of shared experiences. Group therapy is predicated on this idea of shared experiences, but few disorders are exactly the same in manifestation. When it comes to PTSD with veterans, that idea of shared experiences is extremely effective. Not only being in the same war, but training and preparation for war pre-PTSD could help give each other a boost while in group therapy of how to cope with it and move on with the disorder.

PTSD is just as a debilitating disorder as any. Like other illnesses new practices and treatments are being researched and discovered daily. Hopefully with new advances like Virtual Reality and Imagery Rescripting, it will provide effective treatment to those veterans who are in need.

Have a great Monday!

**Authors: Imagery Rescripting and Exposure group treatment of PTSD. Mary E. Long, Marry E. Hammons, Joanne L. Davis, B. Christopher Frueh, Myrna M Khan, Jon D. Elhai, Ellen J. Teng.

Thursday, March 1, 2012

PTSD and Veterans: Part one

Two weeks ago, I posted a very short blog about PTSD and veterans. That post focused on a small part of the negative consequences that a veteran endures when suffering with the illness of PTSD(aside from the actual illness). 

Today, we will go into what may be a potential barrier for a veteran to receive the appropriate attention to treat PTSD. 
In July 2010, President Obama passed new regulations in expediting veterans in receiving the appropriate services to treat PTSD. It appears that it will help in receiving services, but not to expedite through the bureaucratic red tape.  James Dao, a wrote a column in the New York Times, Groups Find Trauma Rule Veterans Lacking and reported that even though the new regulations help, it does not solve the problem entirely. He reported "[the bill]eliminates a requirement that veterans document specific events like firefights or bomb blasts that might have caused their P.T.S.D...At issue is a provision saying that a final determination on whether a veteran’s disorder is tied to service — instead of, say, a car crash — can be made only by a physician or psychologist working for the Department of Veterans Affairs." This means if you are not an employee of the VA, a private practitioner could not do the evaluation and therefore the evaluation becomes useless.

To me this is absolutely  ludicrous and I don't me the rapper, I mean literally asinine for so many reasons. Three reasons in particular. 
One: While I am sure the mental health professionals within the VA's are qualified, I am almost certain that each VA has a "quota" that they need to fill. Whether it be for clinicians to have certain amount patients in their case load or the agency having to fulfill a census to continue its federal funding. 
Two: Two words- Public Relations. The VA wants to be sure that the American public and future veterans know that they are at the fore front of spear heading good practices and treatment for our heroes. Doa, goes onto report that the reason for keeping it "in house" is to assure "consistency in examinations". Really? You actually think that a psychologist or social worker at the VA would come up with such a different diagnosis than a private practitioner. 
Three: Stigma still exists, what happens if a particular veteran does not feel comfortable in seeking treatment in a clinic type setting and would rather be treated in a small office? Now you are forcing the veteran to put them self in a position of possibly not seeking the help, because a private practitioner may make an "inconsistent examination" according to the VA! C'mon man!

Time will tell in the end, what the most effective way to treat our veterans...if I were a betting man...which I am...I don't think this will ultimately be the best way. If you are curious of how bad a problem this is, it is reported that 18 veterans a day commit suicide...That's on you Washington!

Next post will focus on treatment options and new practices on treating veterans with suffer from PTSD.

Happy almost weekend and Happy Social Work month!