How Do You Handle Emotional Triggers?

“(…) in mindful reflection, we go beyond the surface to see what’s underneath. A mindful person reflects on skills and “unskills” and holds each equally. We reflect to learn. We reflect so that in the present and future, we can maintain the positive and not support the negative. In reflecting, we don’t aim to unscrupulously assess our accomplishments or dig into wounds and then judge ourselves harshly about where we came up short. No. Mindful reflection seeks to not to assess, not to judge but to see clearly—“to be a viewer of our own movie” to see what was underneath our thoughts, feelings, reactions, responses as we moved through life in the last year, in the previous day, in the last moment. We are not trying to find the wrong person we were or the right person for that matter. With friendliness, we seek the motivations, the understanding, and the mental states we experienced (i.e., exploring questions such as, Was it anger in that situation that caused my hurt? What else was going on for my co-worker when we had that unfortunate exchange? What did I expect of my family at that gathering?) It is this spirit of looking underneath that we may learn from the past to live our lives more skillfully in the present and going forward.”

Bhante Sathi
Mindfulness Group Discussion
Triple Gem of the North
Chaska MN, January 2020

The True Cost of Cannabis

The true cost of cannabis: Why don’t its illnesses, deaths command media headlines?

In August, I started covering vaping lung injuries from high-potency THC. Next, I added the link between cannabis and mental illness, but it’s lonely.JAYNE O’DONNELL | USA TODAY | 1:10 pm EST January 3, 2020

Whether it’s cocaine, vaping or even your phone, addiction can alter your brain without you even being aware.JUST THE FAQS, USA TODAY

I’ve covered things that injure, sicken and kill kids and adults for more than 30 years. From auto safety to medical errors, I’ve competed to break stories on the latest deadly defect or health policy change, most recently on electronic cigarettes.  

In late August, I added vaping-related lung illnesses to the beat. Last month, I added marijuana, psychosis and other mental illness. 

It’s a pretty solitary place to be. 

We reporters covered the heck out of vaping lung illnesses starting in August. Once it became clear the culprit was THC and not nicotine, however, the news media seemed to lose interest, said former Food and Drug Administration chief Scott Gottlieb at a breakfast event I attended in early November. 

Indeed, a search on the news archive Nexis shows that the number of stories mentioning “vaping” and “lung illness” went from 953 in September to 584 in the first 30 days of October, a nearly 40% drop. 

The deaths and injuries from lung illnesses are declining, but they’ve hardly abated and are clearly a sign of a much larger problem with excessive marijuana use among young people. Yet families from the D’Ambrosios in California to the Donats in Connecticut were caught unaware. 

Families caught by the consequences

Ricky D’Ambrosio, 21, was in a medically induced coma for four of the 10 days he was hospitalized in late August after vaping THC he bought from a dispensary. He had a medical marijuana card.

Vape shop owner: I quit smoking thanks to electronic cigarettes. Banning flavors will hurt adults like me.

D’Ambrosio’s recovering well now, but my Connecticut high school friend Billy Donat’s family wasn’t so lucky.

On Dec. 29, Donat emailed me for the first time ever. It read:

“Sometimes we reach out to old friends at the worst of times, this is one of those times. On Christmas Day, my son of 22 years put an electric cord around his neck and hung himself one day after his release from Yale Psychiatric Hospital. On the table in the living room was a copy (of) USA Today dated 12/16/2019. I told my son that you had written an article about his condition linking pot to psychosis. SCHIZOPHRENIA. I had read the front page at the news stand. I wish I had turned to page 6 and finished the article.”

John "Jack" Donat, left, is shown on Dec. 16, 2016, with classmates in Arundel, Maine. He died by suicide on Christmas Day 2019, a day after his release from a psychiatric hospital where he was being treated for cannabis-induced schizophrenia.

John “Jack” Donat, left, is shown on Dec. 16, 2016, with classmates in Arundel, Maine. He died by suicide on Christmas Day 2019, a day after his release from a psychiatric hospital where he was being treated for cannabis-induced schizophrenia.FAMILY PHOTO

If he had, he would have seen that the federal “mental health czar” and psychiatrist, Dr. Elinore McCance-Katz, lamenting how little attention the “settled science” on pot and psychosis gets and the huge increase in suicides among young people with marijuana in their systems in Colorado.  

On Tuesday, the Centers for Disease Control and Prevention said 2,561 people have been hospitalized with vaping-related lung illness and 55 have died. That’s one more death and over 50 more hospitalizations from two weeks earlier.

CDC says 80% of hospitalized patients who had complete information about their products reported vaping THC; 13% said they vaped just nicotine. 

Most everyone I talk to — even some doctors — say nicotine vaping and Juul, especially, is what’s clogging kids’ lungs. If it is, it hasn’t been identified by any of the many state or federal scientists who have reported on their findings. They have only been able to find vitamin E acetate from THC oil in patients’ lungs

There has been an outcry to ban flavored electronic cigarettes — or all of them, as in San Francisco — and Congress voted to raise the age for all e-cigarette tobacco products to 21 last month. The Trump administration announced plans Thursday to restrict most flavors of the one-time-use pods in e-cigarettes

Jack Donat in Milford, Connecticut, in March 2017.

Jack Donat in Milford, Connecticut, in March 2017.FAMILY HANDOUT

But what about when the industry isn’t an easily identified and demonized monolith like Big Tobacco or … Juul? What if the purported problem is something advocates have been trying to get mandated or legalized for years? 

That sounds a lot like air bags to me — and the kind of resistance my former colleague Jim Healey and I faced in 1996 when we wrote that air bags had killed about two dozen kids and that regulators weren’t telling the public. Our stories led to the warning labels and smart air bags now in every new car.

Air bags were saving adults’ lives! There’s always a trade-off, isn’t there?

Press lets pot’s bad news slip by

Former New York Times business reporter Alex Berenson says that the human cost of cannabis is too high — and that the press is too pro-pot. When his latest book, “Tell Your Children: The Truth about Marijuana, Mental Illness and Violence,” came out early last year, Berenson knew marijuana proponents wouldn’t like it. He just didn’t think there would be what he calls a “media brownout.” No major publications reviewed it. 

Alex Berenson is the author of "Tell Your Children: The Truth About Marijuana, Mental Illness and Violence.

Alex Berenson is the author of “Tell Your Children: The Truth About Marijuana, Mental Illness and Violence.CRAIG GELLER

Reporters from major U.S. newspaper companies never contacted him for stories, although those in eight other countries — including Japan, Italy and Australia — did. (USA TODAY interviewed him for a March article.) Public radio and a suburban New York school system canceled appearances. 

Berenson, a registered independent who didn’t have strong feelings about marijuana legalization until he researched his book, has become an unlikely favorite of the conservative media and think tanks. He blames what he says is “a genuine misunderstanding of the strength of the science supporting the cannabis-psychosis link,” which is worsened by “the endless industry/advocacy yelling about ‘Reefer Madness.’ ” 

A decade in review: The surprisingly good news about American family life — for kids

Reefer Madness” was a 1936 movie that used crazed marijuana users to show the purported risks of the drug. 

“The cannabis lobby … will personally attack anyone who tries to raise the issue,” Berenson says. 

His “not so secret weapon,” however, is that “I no longer care what anyone says about me,” he says. “I know what the facts are, and I’m going to repeat them until someone pays attention.” 

Last month, the National Institute on Drug Abuse reported new data showing marijuana use by students from eighth to 12th grade was way up — with 1 in 5 high school seniors vaping it in the past year.

The recent story I wrote with colleagues on marijuana’s link to mental health ran on the front page and was one of the top stories on our website for days. More than 250 people with children or personal experience with mental illness linked to marijuana joined our Facebook support group — I Survived It

I don’t know about you, but that makes me pay attention. 

Brad Pitt Reveals Bradley Cooper Helped Him Get Sober in Moving Acceptance Speech

Brad Pitt Reveals Bradley Cooper Helped Him Get Sober in Moving Acceptance Speech

PNL

JAN 09, 2020

brad bradley
Image via Getty

Brad Pitt doesn’t talk about his struggles with alcoholism often, but he opened up a bit at the National Board of Review Annual Awards Gala on Wednesday night.

The Once Upon A Time… In Hollywood star won Best Supporting Actor at the gala, and was presented the award by another well-known Brad, Bradley Cooper. The 56-year-old actor embraced Cooper on stage and then revealed that his good friend helped him get sober.

“Thank you, Bradley. Bradley just put his daughter to bed and then rushed over to do this,” the actor joked, referring to Cooper’s young daughter, Lea. “He’s a sweetheart.”

“I got sober because of this guy,” Pitt continued, in a heartwarming moment. “And every day’s been happier ever since. I love you, and I thank you.”

Matt Neglia@NextBestPicture

Brad Pitt accepts the Best Supporting Actor Award for ONCE UPON A TIME IN HOLLYWOOD from Bradley Cooper at #NationalBoardOfReview #NBR1,0258:31 PM – Jan 8, 2020Twitter Ads info and privacy225 people are talking about this

He also joked a little about the National Board of Review during his acceptance speech. “I know very little about the National Board of Review,” he said. “You guys have been around for a century? I know so little, other than you love films. I started to Google you, look you up and I thought, ‘Fuck it! I love films too. That’s good enough for me.”

The Ad Astra actor joined Alcoholics Anonymous after divorcing Angelina Jolie in 2017 and has been sober ever since. In an interview with GQ Magazine back in 2017, he said he let alcohol go because he didn’t “want to live that way anymore.”

“I just ran it to the ground,” the actor recalled. “I had to step away for a minute. And truthfully I could drink a Russian under the table with his own vodka. I was a professional. I was good.”

DBT in the Treatment of Addiction

DBT in the Treatment of Addiction

By Regina Walker 06/15/15

One of the more promising therapies for addiction, Dialectical Behavioral Therapy, or DBT, was developed to help treat compulsive patterns of self-harm with simple, practical, and effective techniques.

dbt.jpg

What is addiction? There are many definitions, but one of the most basic features of any addiction is that there is a compulsive repetition of behaviors that are known to be harmful—no matter how good they feel initially—but are chronically engaged in nonetheless. The tools for harming oneself might be alcohol, drugs, cutting, overeating and unsafe sexual practices (amongst others) but the result is the same.  

One of the more promising therapies for addiction, Dialectical Behavioral Therapy, or DBT, was developed by its inventor, Dr. Marsha Linehan to help treat compulsive patterns of self-harm with simple, practical, and effective techniques. For Linehan, DBT is anything but an exercise in abstraction. As she only recently revealed, its methods come from insights gained, at a huge personal cost, from her own struggles with mental illness. Though Linehan was never a substance abuser per se, she was nonetheless, like many substance abusers, trapped in a downward spiral of shame, self-loathing, psychic pain, and self-harm from which there seemed to be no escape.

Linehan originally developed DBT as a treatment for highly suicidal patients often with a compulsion to injure themselves. Such patients are now often diagnosed with Borderline Personality Disorder, a psychiatric illness characterized by sometimes lifelong patterns of violent mood swings, unstable relationships, poor self-image, and a tendency to act impulsively. Often, there are also persistent feelings of abandonment and the majority of those with a BPD diagnosis harm themselves, as well as make repeated suicide attempts. Dr. Linehan believed that if these individuals could be taught skills to better deal with emotional and life issues and thus lessen psychic pain, then the desire to be dead or harm themselves would be greatly diminished. The goal of DBT is to acquire skills to deal with the mental anguish the sufferer experiences and create a life worth living. The tools offered in DBT are meant to aid in the achievement of these goals.

Dr. Linehan was, at first, diagnosed with schizophrenia at the age of 17. As a teenager she was, according to an in-depth look at her struggles with mental illness published in the New York Times in 2011, “precocious” but also dangerously violent towards herself. “The girl,” wrote Times correspondent Benedict Carey, “attacked herself habitually, burning her wrists with cigarettes, slashing her arms, her legs, her midsection, using any sharp object she could get her hands on.” In the same story Linehan said, “I felt totally empty, like the Tin Man; I had no way to communicate what was going on, no way to understand it.” She was “dosed with Thorazine, Librium, and other powerful drugs, as well as hours of Freudian analysis; and strapped down for electroshock treatments … nothing changed, and soon enough the patient was back in seclusion on the locked ward.”

In 1967, Linehan had what can only be described as an epiphany: she had been regularly praying at the Cenacle Retreat Center in Chicago, and had suddenly felt transformed. “It was,” she told the Times, “this shimmering experience, and I just ran back to my room and said, ‘I love myself.’ It was the first time I remember talking to myself in the first person.'”

“The high,” Carey writes, “lasted about a year, before the feelings of devastation returned in the wake of a romance that ended. But something was different. She could now weather her emotional storms without cutting or harming herself.”

Quite simply, she accepted herself as she was. She referred to this as “Radical Acceptance”—acceptance of life as it is, not as it is supposed to be; and the need to change, despite that reality and because of it. These seem to be opposites: on the one hand, you have to take life as it is; on the other hand, that change is essential for survival. But for real change to happen, both self-acceptance, and acceptance of the need for change have to come together. This blending of two seemingly opposite views is called a dialectic—and it’s the vision behind the name of Dialectical Behavioral Therapy.  

Dr. Linehan acknowledged that the self-harming behavior she saw in suffering patients made sense and had a purpose.

Over time and study (she earned a Ph.D. at Loyola in 1971), Dr. Linehan acknowledged that acceptance and change alone were not enough and people needed tools to handle the feelings and circumstances in their lives that led to self-harming behavior. 

Substance abuse is a self-harming behavior. Addicts will often suffer numerous negative consequences from their substance use (failing health, job and relationship losses, legal difficulties, and economic problems to name a few) yet despite the negative consequences, many will continue to use to experience even a short reprieve from discomfort or pain. Many studies show a strong connection between BPD and substance abuse disorders.

DBT, for people struggling with substance abuse problems, is a way to achieve self-acceptance while simultaneously accepting the need for change. There are four basic aspects to DBT: mindfulness, interpersonal relations, emotion regulation, and distress tolerance.  

Mindfulness is an idea originally borrowed from Zen Buddhism. Mindfulness is quite simply about becoming focused on the present moment as opposed to the past or future and to be aware and accepting of what is happening both within and outside without making judgments about the experience. This can also be described as acceptance of the self and of the circumstances.

The next skill-set in DBT focuses on interpersonal relations. This “module” (as the training experience of DBT is presented) teaches how to set limits and safeguard oneself and relationships.

The emotion regulation aspect of DBT teaches how to identify, regulate and experience emotions without becoming overwhelmed and acting on impulse. The skills aim to reduce vulnerability and increase positive experiences.

The fourth area of DBT is distress tolerance. This area is focused on the development of skills to cope with crises when emotions become overwhelming and the individual is unable to immediately solve the problem (a death, sickness, loss of job, etc.) but needs to persevere and live through the crisis without making it worse by impulsive actions (for example, getting high or drunk).

In the quest for abstinence, DBT pushes for immediate and permanent cessation of drug abuse (change) while also offering the idea that a relapse, should it occur, does not mean that the individual cannot achieve the desired result (acceptance). The dialectical approach therefore joins unrelenting insistence on total abstinence with nonjudgmental, problem-solving responses to relapse, which include techniques to reduce the dangers of overdose, infection, and other adverse consequences.

DBT treats a lapse into substance abuse as a problem to solve, rather than as evidence of patient inadequacy or treatment failure. When a patient does slip, the therapist shifts rapidly to helping the patient fail well—that is, the therapist guides the patient in making a behavioral analysis of the events that led to and followed drug use, and gleaning all that can be learned and applied to future situations. Additionally, the therapist helps the patient make a quick recovery from the lapse. This approach may lessen the intense negative emotions and thoughts that many people feel after a lapse and that can hinder reestablishing abstinence. (“What’s the point? I’m a failure. I can’t do this. I give up. I might as well keep using.”) 

The idea of failing well also involves repairing the harm done to oneself and others during the lapse. This concept is similar to making amends in steps eight and nine of the 12 steps of Alcoholics Anonymous, and serves two functions. It increases the awareness and memory of the negative consequences of using drugs while also directly dealing with the adverse effects of using—specifically, “justified guilt” that is, being able to accept that it’s appropriate to feel guilt, regret, and a desire to change, as a result of negative acts. (For example, stealing money to buy drugs.)

In DBT with substance abusers, the clinician enters into an agreement (“abstinence pledge”) with the patient that he/she will remain abstinent for a specific amount of time. Since many substance abusers would find a lifetime of abstinence overwhelming, the “contract” is for a set period of time and “renewed” when the time period ends. The rationale behind this is that the goal needs to feel “achievable” so the amount of time is negotiable between the therapist and client. In some ways, this mirrors the “one day at a time” philosophy found in 12-step programs.

Clients are then taught strategies for dealing with potential problems including “triggers” to use drugs and/or alcohol. This “coping ahead” skill is the DBT equivalent of relapse prevention. It acknowledges that an addict’s fallback coping mechanism in many situations is to use and it is essential that the individual identify other tools for addressing difficult situations ahead of time.

During her first psychiatric hospitalization, Dr. Linehan remarked, “I was in hell. And I made a vow: when I get out, I’m going to come back and get others out of here.” Addiction is very often described as a sort of hell—a world of dependence, pain (both physical and mental), desperation, and loss. DBT may be a useful roadmap out of hell—a way of realizing that feelings aren’t something to avoid or diminish with drugs or alcohol, but the actual fabric of life itself.

Regina Walker is a regular contributor to The Fix. She last wrote about what to do now you’re sober.

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