Sad girl by fence For anyone facing the demon of substance abuse, one of the most difficult challenges is understanding how their addiction is affecting the people around them, including family and friends. In a haze of drugs and alcohol, it is virtually impossible to understand the impact that substance use and addiction have on the people who are closest. This dynamic is especially prevalent when parents are the substance abusers and they are unable to conceptualize how their use is impairing the growth and development of their children.

When a parent drinks too much or is under the influence of a substance, legal or illegal, many kids are likely to find themselves overwhelmed and unable to deal with their emotional reality. Children may deal with feelings of anger, embarrassment, frustration, fear, and myriad other emotions that they may not know how to express.

If there is substance abuse occurring in the home, often the family will try to manage the fallout internally, leaving kids with the feeling they have to protect a family secret. Sometimes, addiction may be influencing one or both parents in a household, but no one in the family unit is willing or able to address the issue. Even a suggestion that there may be problems with addiction can bring anger and backlash from a parent who is not ready to face his or her own substance issues.

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Substance use can also make home a dangerous place for kids. The addicted parent may not be able to maintain work or a steady income, rendering home life unstable. The potential for abuse also rises in households where one or more parents are under the influence. This lack of stability may adversely affect the emotional development of children, leaving them lost, lonely, and stressed.

The long-term effects of these experiences will influence kids in many aspects of their daily lives. Kids of addicted parents often take on responsibility for the household and become what is commonly called the “parentified” child. Such kids are forced into adult roles and responsibilities that are not being managed by the parents. They may become perfectionists in an effort to manage the emotional instability in the home.

These same kids often carry low self-esteem and face challenges when trying to create intimate relationships outside the home. They often have limited emotional awareness and may be conflict avoidant as a means of maintaining a steady emotional state. Holding the secrets of the addicted parent(s) makes it hard for them to build open, honest relationships, which in turn makes it challenging to develop close connections.

All of these are reasons to find help for kids in families with addiction issues. If one parent, family friend, or relative can step in and recognize the issues occurring in the household, there is a window of opportunity to get professional assistance.

It is vital for kids of alcohol- or drug-addicted parents to realize that they are not alone and that there are other people in their community facing the same challenges. It is also important, with the assistance of a professional counselor or support group, for kids to understand that they are not responsible for the addiction issues that their parents are going through. Having a place to share their story and make sense of the emotional turmoil in their home may help kids of addicted parents to process their feelings and begin to develop a stronger sense of self.

The development of self-esteem, independent of a parent’s addiction issues, can help children to regulate their emotional life and adapt to family needs. By providing a place of safety and understanding for kids of addicted parents, we can help children learn healthy coping skills and understand how addiction can affect any home, not just theirs.

Thank you for your letter. This kind of issue comes up frequently with couples, particularly early on in one’s marriage or partnership. It often involves a topic that has potent but conflicting meanings for the people involved. A classic, somewhat stereotypical example is the guy who is a fanatic for his home team and MUST watch the game. His spouse (or partner, I use the words interchangeably here) may roll her (or his) eyes or argue or whatnot; clearly, each person sees the activity or event differently. It may be the same for a woman who just HAS to see Bruno Mars or Dave Matthews or Prince for the first or umpteenth time, or buy those Jimmy Choos at 25% off.

In this case, the symbolic “event” or activity revolves around something even more potentially charged with meaning: alcohol and drinking. Alcohol is symbolically loaded (no pun intended) for many who have complicated histories with drinking and corollary activity. I’d be interested—were I your couples counselor (and this is all conjecture, mind you)—to know the roots of your wife’s concerns. Did she have a former partner who drank too much and/or cheated on her? You say, “I don’t think she trusts me,” which to me hints that there hasn’t been a direct conversation about this. It’s striking how often couples don’t communicate directly with each other, usually because we’ve never learned how to in our own families. It helps to speak one’s concerns directly to your partner—how you feel about it—for the purpose of understanding first, before “winning” the argument. Because it has to be win-win (or else it’s lose-lose).

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Listening is, in a way, even more important than direct expression of emotion; try to “mirror” the other person’s point of view emotionally, without interjecting commentary or editorializing, which means you might say, “I hear you saying it bothers you when I do this because (fill in the blank).” “It sounds like you’re feeling worried or frustrated about (blank).” Focus on the feelings, and don’t worry just yet about finding a compromise or solution (or “proving” your point). I find that couples often find such answers organically once their heart-centered listening is in place. It sounds like she really values her connection with you (a wonderful thing) and gets anxious about whatever this activity symbolizes for her. Perhaps her best friend’s husband hit on a girl at a bar and they broke up. Perhaps her dad was a womanizer, or ignored her mom by hanging with his buddies at the pub … and so on. (Hold Me Tight by Sue Johnson is a good book on this, by the way.)

I would also encourage her to listen to you and what these evenings mean for you. Rather than get into a tug-of-war power struggle—yes I will go, no you won’t, you’re not the boss, etc.—I would first suggest you reflect on why this is important, then communicate this to your wife. It sounds like this has become a necessity for you, and that raises my curiosity. What is it about this activity that feels essential (versus, say, a round of golf or a movie)? Both you and your wife would need to understand that before it’s “taken” from you. Maybe you had a controlling ex-partner, or maybe you saw your father controlled by your mom, which created marital strife, or maybe you believe your wife is overreacting or patronizing. Most people don’t like to be told what to do—or rather, “feel” like they’re being told what to do. (Often, requests, needs, or feelings are either stated or misinterpreted as demands.) The first step would be to state these feelings to her while keeping the focus on you and your feelings, rather than, “You’re being a controlling pain when you (blank).” Then she might try reflecting this back to you, so you each “try on for size” the other’s perspective without trying to negate, shoot it down, etc.

I had a tiny niggling intuition while writing this column that maybe your wife feels like ONLY a few rounds with the lads does the trick—while she’s kept at a distance. Perhaps her anxiety about being distant leads to you somehow feeling over-controlled (the classic pursue/avoid game). Perhaps she feels excluded (while you feel controlled and perhaps criticized). My hope is that after you share your feelings, you find an activity together. Maybe your wife could join you for a round one of those nights; maybe you could have people over to your house to watch the game. The guys can watch the game while the gals either join in or do something else. Or have a weekly barbecue. Something inclusive. There’s a very either/or tone to what you’re describing and a separateness that may be at the heart of what’s bothering your wife, who obviously wants to share your experience with you—togetherness and sharing are essentials for healthy long-term relationships. You’re both right, and both points of view need to be honored to prevent corrosion to the relationship. Hope that helps! Thanks for writing!

Kind regards,
Darren

AddictionAddiction occurs when a person becomes physically or psychologically dependent on a substance, thing, or activity, generally leading to withdrawal symptoms when it is unavailable. Many people engage in potentially addictive behaviors recreationally, but when those behaviors are abused to the point of interfering with day-to-day functioning at work, in the classroom, at home, or in relationships, it becomes a serious issue that may require intervention and treatment.

Faces & Voices of Recovery claims on its site that more than 21 million people experience addiction and are not yet in recovery, and according to the National Council on Alcoholism and Drug Dependence, approximately 17.6 million people in the United States experience alcohol abuse or dependence, along with millions more who partake in risky behaviors such as binge drinking. The all-consuming nature of addiction takes a physical, mental, and emotional toll on the addicted person and on those who love and care for him or her. It follows that recovering from addiction takes time, dedication, and support—and ultimately, the addicted person must be the one to summon the resolution and determination to make a full recovery.

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Thankfully, there are several resources available for coping with addiction, be it yours or that of someone you care about. We’ve compiled a list of the 10 best ones—GoodTherapy.org excluded—for 2013. As with our previous top 10 lists, our selections are based on quality and depth of content, presentation, and functionality.

Nominate another website for our Top 10 awards here.

GoodTherapy | Three Reasons to Leave: Abuse, Addiction, and AffairsAs a clinical psychologist and certified addictions counselor, I see husbands, wives, and partners in individual or couples therapy on a daily basis grappling with the decision to leave or divorce their spouse or partner. Therapists have long referred to the three “A’s” of divorce as legitimate reasons to consider ending a relationship when the behavior of one’s partner is clearly destructive, abusive, or there is no reason to believe it will improve. Psychologists have suggested that the top three reasons for divorce are abuse, addiction, and affairs.

Researchers have long reported that financial problems are the top area of conflict for most couples, and that communication is the second most-cited reason for marital discord. While that may be true, these problems pale in comparison to the severe and devastating consequences resulting from abuse, addiction, and affairs.

When people ask me whether they should leave their partner or initiate divorce proceedings, very often it is because of one of the above. Any one of these issues, in and of itself, can be severe enough to make the answer to this question simple, yet it is an intensely personal and complex choice and the decision must be made in the context of careful consideration for oneself, one’s family, and the state and federal laws pertaining to the behavior. It is of utmost importance that, when faced with a partner who is engaged in these behaviors, one consults a professional and receives support, education, and counseling.

These are not decisions that should be made in a vacuum—or alone. As the social creatures and pack animals that we are, we have evolved over time to need and rely on social supports to better understand ourselves and the situations in which we find ourselves. Seeking help and support is a necessary, if not sufficient, first step in making the right decision for ourselves when coping with addiction, affairs, or abuse.

Many people do recover. While keeping safety in mind first and foremost, any one instance of the three “A’s” may be something that couples can bounce back from if they receive enough help and support.

[fat_widget_left]One person with whom I worked found that she began to have feelings for a man she met online who was living in another state. She had no physical relationship with this man, but she continued to be connected with him for two years in what she later determined to be an emotional affair. When she and her husband finally entered couples therapy, she was able to confess her feelings for this man and her “emotional infidelity,” and end the affair promptly. She was able to work on what led her to stray from her husband and to articulate the ways in which she felt she was not getting her needs met at home and in their relationship, and they were able to make changes in order to save their marriage.

Another case of forgiving a violation of the three “A’s” involved a couple in which the man was physically abusive. He would block his wife’s exit from a door when she wanted to leave the house, jealously hack into her email, listen to her phone messages, and place restrictions on when she could go out and with whom she could spend time. At one point, he shoved her and she fell, almost bumping her head on a coffee table. While these are considered abusive behaviors in most states and punishable by law, the couple was able to learn about the definition of abuse—physical, sexual, and emotional—and the man fully engaged in individual and group counseling. He found a local therapist who ran groups for men with anger and physical abuse problems, enrolled in that program, and worked hard on himself for two years to save his marriage and family.

Often, couples enter counseling when marriages are on the brink and it becomes clear that one or both partners need individual counseling before the couples work can be successful. This last case is an obvious example where individual therapy would be essential at the start. The husband in this instance began individual therapy and conjoint group therapy, focusing on anger management and coping skills. Most importantly, he was able to identify and stop the abusive behavior, and the couple was able to resume their progress in couples counseling. After significant time and work, they were able to salvage their relationship and the marriage. This involved the wife’s ability to forgive and trust her husband again, of course, but also the husband’s ability to express his anger toward her in a more acceptable, healthy, and helpful way. The wife certainly needed her own individual therapy before she was even close to being willing to begin the couples counseling.

Addiction may be no different from affairs and abuse in this regard. When one’s addiction is severe, it is clearly grounds for ending a relationship or getting a divorce, but by no means is this always the case. When a husband, wife, or partner adequately addresses his or her drug and alcohol issues or other addictive issues, such as shopping addiction, gambling, or love or sex addiction, a couple can recover from the hurt, shame, and consequences of the addictive behaviors.

Many people are familiar with the quote, “We’re not responsible for falling down, but we are responsible for getting back up.” This is a wonderful analogy for the “disease” model of addiction. If you are walking along, don’t see a hole, and you fall in it, it isn’t your fault. It is, however, your responsibility to get up, to get out of the hole or ask for help. An individual with an addiction is not responsible for having the disease. It is sometimes a hereditary illness, a brain disease characterized by chronic relapse with psychosocial, biological, personal, and cultural origins. However, once someone knows that they have an addiction, they are responsible for picking themselves up, getting treatment, avoiding people, places, and things associated with their addiction, and working a program of recovery involving therapy, meetings, and the use of a support network such as a 12-step fellowship.

A few important things to remember: The three “A’s” and the behaviors surrounding them need to cease right away. In some cases this can be a work in progress, but in others it can’t. Physical, sexual, and emotional abuse needs to stop immediately. Some of these behaviors are obviously illegal and nonnegotiable. There is no way to continue an affair and work on one’s marriage at the same time. Individuals need a comprehensive assessment and evaluation to determine the appropriate level of care and to engage in the level of treatment and support that will keep them and others safe. After this is determined, if treatment is not working adequately and that level of treatment is deemed insufficient, then the individual will need to step up his or her treatment to a higher level of care.

Often, separation is a good idea as couples learn about the addiction, affairs, or abuse. A healthy separation can enable individuals to focus on their treatment and come together as needed when both are ready. This sort of separation enables both parties and their family to recognize that recovery is an individual’s responsibility and it is also a family affair. Whether children or extended family know explicitly about what is going on, to be sure, they are all affected. So when an individual begins recovery, so too does the family, and each member of the family may need support and/or counseling.

It is a spouse’s or partner’s responsibility to communicate to his or her partner what is acceptable and what is not. It is also incumbent on a spouse or partner to become educated about the law, about the disease of addiction, and to learn as much about the psychological underpinnings of the three “A’s” and these sorts of behaviors as possible. It is a partner’s responsibility to communicate as clearly as possible about what he or she believes is going on and to insist that his or her partner get help.

Rarely is anyone able to work through these sorts of problems without the support of professional help. Finding someone to help you and your spouse these days is very easy, however. GoodTherapy.org’s therapist directory is a great place to start. You can also contact your local city or state psychological society or association. Speak with a physician or friend you know who has been in counseling and ask them or their therapist for a referral. Most local therapists are willing to consult at no charge over the phone to help you determine if they might be a good match for you or your spouse.

Did you ever hear the saying, “Friends don’t let friends drive drunk”? Friends don’t let friends live their lives drunk, either. From your description, her behavior sounds like she may be addicted to alcohol, or someone who abuses alcohol and is at risk of becoming addicted. Alcoholism is a chronic, dangerous issue.

You were a good friend and told her that she is courting trouble; sometimes it hurts to hear the truth. When you told her that her behavior was ruining her relationships, yours included, she got angry and accusative. It sounds like she needs help, just as you told her. She’s lost her boyfriend and her job and is sponging off her mom. “She blows up at everyone around her,” you wrote. This is one of the many symptoms of alcoholism.

Does her mother understand where the money is going? It sounds like the mom is being used, and, as you say, the mom’s money is enabling your friend’s dangerous behavior. Perhaps the mom gives her daughter money because she feels sorry for her. People with alcoholism are experts at playing on others’ feelings so they can get what they want. You’re her best friend, and you’re trying to stop her from ruining her life. Rather than thinking about what you are saying, she accuses you of always judging her and telling her what to do. And maybe you do.

I once heard someone describe stopping drinking as like “stopping a speeding express train barehanded.” Your friend may have to hit bottom before she can begin the long climb back. I know you want to help her, but people can’t be helped if they aren’t willing and able to accept help. Stopping her is not in your power. She can get better, but she has to choose to first, and then she has to work long, hard, and with great determination. No one can do it for her.

You ask who owns this problem—clearly, your friend does. The problem is hers to do something about. Or not.

My opinion: She should join a 12-step program, consult a therapist, and perhaps a psychopharmacologist, too. Remember, alcoholism is a very serious issue, and needs professional treatment—much more than even the best of friends can give her. It sounds like you have already given her a great deal; perhaps it’s time for you to step back.

If you want to remain her friend, you might consider joining Al-Anon, which focuses on problems common to family members and friends of people with alcoholism. Some of those problems are loyalty to abusive people and a tendency toward excessive caretaking. Does this sound familiar?

You need support, too. A tough-love approach might be helpful for you both, and you would benefit from the backing of other Al-Anon members who know how to negotiate the alcoholism territory, which is a rough one. As when you’re in the jungle, you need a compass and companions so you can work together and find your way out—you and your friend, both.

I wish good luck to both of you.

Best wishes,
Lynn

Welcome matThe term “enabler” has gained widespread recognition and use in popular culture and media over the past several decades. It is a label that can result in a great deal of anxiety and guilt for anyone who has been accused of being, or suspects that they may be, an enabler.

In its original context, enabling refers to a pattern within the families of people addicted to alcohol and drugs, wherein the family members excuse, justify, ignore, deny, and smooth over the addiction. This notoriously allows the addicted person to avoid facing the full consequences of his or her addiction, and the addiction is able to continue.

In a wider sense, enabling can describe a pattern of behavior that becomes organized among the family and friends of not just an addicted person, but any person who is exhibiting poor choices that harm themselves or others and for which they are not being held responsible.

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Who are enablers? Enablers can be romantic partners, ex-partners, parents, adult children, siblings, or friends. The one thing that all enablers have in common is this: they love someone who is out of control, and they find themselves taking more responsibility for the actions of that person than the person is taking for themselves.

The one thing that all enablers have in common is this: they love someone who is out of control, and they find themselves taking more responsibility for the actions of that person than the person is taking for themselves.

Who is enabled? The enabled person may be one who is refusing to take on responsibilities he or she would otherwise be expected to take on in the course of age- and stage-appropriate development. The enabled person may be exhibiting a range of poor choices with alcohol and drugs, ranging from abuse to addiction. This may also encompass poor choices around so-called “soft addictions” such as gambling, pornography, or excessive video gaming. He or she may refuse, or appear unable, to fulfill normative roles of adulthood. If a parent, he or she may underperform or disregard the responsibilities of parenthood. He or she may frequently disrupt romantic partnerships. The enabled person often displays poor money management, as well as disorganized academic and/or career-planning choices. He or she may quit or be fired from a series of promising jobs and educational or training programs. The enabled person often describes himself/herself as a victim of circumstances or of other people.

The enabled person’s behavior elicits a great deal of anxiety within the people who love him or her. This creates a dysfunctional system into which people who are close to, love, or care for the person can become enmeshed: compelled to organize their own behavior around the needs and choices of the enabled person.

Some who use the term “enabler” do so with a heavily negative judgment against the person who fulfills the role. It is commonly believed that enablers are knowingly, even willingly, complicit in the actions of the person they are enabling; that enablers support and condone the negative choices of the person they are enabling.

This is far from true. Enablers do not like or feel OK with what the enabled person is doing. To the contrary, enablers are often the ones most affected by, and most disturbed by, the negative behaviors of the enabled person. They feel extremely anxious about the destructive consequences that the enabled person could face.

Consider the following quotes from self-described enablers in therapy:

In other words, enablers detest the behaviors of the enabled, but they fear the consequences of those behaviors even more. They are locked into a lose-lose position in the family. Setting boundaries feels like a punishment, a rejection, or an abandonment of the person they love. Enablers may struggle with the guilt they would feel if the person they’re enabling were “left alone” to be hurt and damaged by the real consequences of their actions. In some instances, enablers are also protecting themselves and/or children from those consequences.

Enabling, therefore, is a distorted attempt to solve problems. Enablers desperately desire to find a solution to the issues at hand, but their attempts to do so are severely limited by the dysfunctional family system.

Enablers frequently find themselves thinking things like:

Enabling has the effect of releasing the enabled person from having to take responsibility for his or her behavior. Enabling means that someone else will always fix, solve, or make the consequences go away. When someone is in the throes of an addiction or other grossly dysfunctional behavior pattern, he or she begins to rely on the resources available. Enabled persons will come to expect that their behaviors are disconnected from consequences or negative outcomes. Enabled persons may even begin to hold their enabling family members in “emotional hostage” in order to keep this pattern going. They may learn to manipulate their enablers in order to ensure that the help and support keep coming.

In this kind of a system, everybody loses by inches. The enabler is desperate to prevent one enormous crisis, but winds up experiencing a constant state of stress as he or she attempts to manage each smaller daily crisis. Enablers generally are aware that they are being taken advantage of in some way; they often report feeling frustrated, unappreciated, and resentful.

The enabled person becomes stuck in a role in which he or she feels incompetent, incapable, disempowered, dependent, and ineffectual. He or she may gradually accept a self-concept that includes these negative traits, destroying self-esteem.

How, then, does the enabled person also “lose”? The enabled person may wish he or she felt in control of themselves, particularly with regard to addiction; but lacking the life experience and lessons that facing consequences brings, they may not know how to break those patterns. They may not have had the benefit of true self-reflection and self-evaluation of their behaviors. The enabled person becomes stuck in a role in which he or she feels incompetent, incapable, disempowered, dependent, and ineffectual. He or she may gradually accept a self-concept that includes these negative traits, destroying self-esteem and rendering the person even less likely to suddenly do a 180 and become responsible and self-sufficient in the future. The enabled person may essentially be prevented from building the skills and motivation he or she needs in order to practice responsibility and reach his or her full potential. Because the enabler(s) will always solve problems for them, the enabled person does not learn how to solve their problems themselves.

By this point, you may be thinking, “I can see some of the ways I have been enabling my loved one. What now?”

You must accept that while your enabling behaviors come from a place of love, enabling is an ineffective way of solving problems at best; debilitating to all involved at worst. You may buy another day or prevent another emergency, but in the end, you are only postponing the real solution.

The key to breaking the pattern of enabling is to return responsibility to the person it belongs to. This involves setting boundaries between yourself and your loved one. You can no longer attempt to take on responsibility for anyone else’s actions but your own. Your loved one’s choices are (and have always been) his or hers. Your loved one’s outcomes and consequences, as well, belong to him or her alone.

The enabled person lives in the same world, with the same rules, as everybody else. Managing their world for them means that they don’t learn to manage themselves within the world. He or she is very likely to have untapped internal and external resources which have not been utilized because the enabling pattern has short-circuited their growth.

When you set boundaries, you release your need to control the outcomes that your loved one experiences. You allow your loved one the chance to connect his or her own choices to the positive and negative experiences that naturally follow. Their choices, their consequences, and what they do or don’t learn from them are all on their side of the boundary.

On your side of the boundary, this means that you must learn to cope with, and internally manage, the anxiety of not being in control of your loved one. Many recovering enablers find that they must rely on their own sources of support to help them overcome the urge to control and enable. The fear of your loved one being hurt can be so overwhelming that setting boundaries and stepping back can be panic-inducing. Receiving counseling for further insight and support in this area is highly recommended.

When you stop enabling, this does not mean that you stop loving the person. It does not even mean that you cannot help him or her.

When you stop enabling, this does not mean that you stop loving the person. It does not even mean that you cannot help him or her. There is a difference between healthy help and enabling. Healthy help involves providing information, encouragement, and coaching to your loved one. You may give your loved one contact information for doctors, counselors, lawyers, or rehabilitation programs, without feeling the need to force him or her to accept this help. You may discuss with your loved one what the possible consequences of actions might be, without feeling as if you must make sure they make the choice you want them to make. Healthy help puts your loved one in control and allows you to take a secondary role.

Enabling is essentially love turned to fear, and help turned to control. The effects of enabling are toxic to all involved. With a solid understanding of what enabling is, and what it is not, there is hope for families who are acting out this pattern. An experienced individual and/or family counselor can be a valuable source of support for anyone who is looking to break enabling patterns.

The number of incarcerated individuals with mental health issues is disproportionately high. Not all people who commit an offense have psychological problems, but those that do often go without care prior to being introduced to the criminal justice system. Having a better understanding of the relationship between offending and mental health issues could help in the development of interventions and identification measures aimed at those most at risk for mental health issues and criminal offense behaviors.

To capture a more accurate picture of the prevalence of psychological problems among offenders, Vera A. Morgan of the School of Psychiatry and Clinical Neurosciences at the University of Western Australia recently led a study that analyzed data from a birth cohort spanning 15 years.

Morgan found that of those who were born during that time, over 116,000 had been arrested and over 40,000 had been registered as receiving psychiatric care. Of those who received psychiatric care, 32.1% were in the criminal justice system. The most common psychological issues in this group were substance abuse and schizophrenia. A combination of these two significantly increased the likelihood of being arrested.

When Morgan looked solely at arrest records, she found that over 11% had a psychological issue, 6.5% had substance abuse issues, and almost 2% had a diagnosis of schizophrenia. When she looked at other mental health issues, Morgan found that personality issues accounted for 35.9% of arrests, and 29.2% of all arrests were among people with psychological conditions other than substance misuse, schizophrenia, or personality issues. For many, being arrested led to their first contact with mental health services.

“Given a growing proportion of schizophrenia offenders being arrested prior to their first contact with psychiatric services, there are important implications for mental health and criminal justice policy and practice,” said Morgan. The development of programs designed to identify mental health issues prior to entering or at the threshold of the doorway into the criminal justice system should be explored in future work. Doing so has the potential to reach individuals most in need of mental health care and also to decrease the risk of offending by those with mental health issues, and in particular, substance abuse and schizophrenia.

Reference:
Morgan, V. A., et al. (2013). A whole-of-population study of the prevalence and patterns of criminal offending in people with schizophrenia and other mental illness. Psychological Medicine 43.9 (2013): 1869-80. ProQuest. Web.

Hands pressed together in prayerChurch attendance in the United States has been dwindling over the past several decades, with people who regularly attend church now accounting for a minority of the population. More than 90% of Americans, however, report that they believe in God, with many harboring faith but not participating in formal religion. More than 30% of Americans report that they are spiritual but not religious.

Spiritual people don’t subscribe to a single set of beliefs. They may simply believe in God but dislike formal religion, or they may combine practices from a variety of religions. Spirituality is frequently associated with new-age and alternative religious practices. A new study published in the The British Journal of Psychiatry finds that people who identify as spiritual are more likely to experience a wide variety of mental health issues than both nonreligious and traditionally religious people.

The Study
The study, which was conducted by researchers at University College of London, involved surveys of 7,403 randomly selected participants. Each participant was asked about his or her religious beliefs, emotional state, history of drug use, history of addiction, and history of mental health issues. Thirty-five percent reported that they were religious. Nineteen percent reported that they were spiritual, and 43% reported no religious affiliation.

The Results
On nearly every measure of psychological well-being, people who described themselves as “spiritual but not religious” fared more poorly than other study participants. Notable findings:

What Does It Mean?
While the study shows that spiritual people may be more vulnerable to mental health issues, it provides little information about why. It could be that people are more likely to identify as spiritual when they have a mental health issue; it could also be that something about spirituality makes people more vulnerable to mental health issues.

Religion provides significant social support, as well as an explanation for life’s suffering. It could be that, absent this support, people are more vulnerable to mental struggles. But even the nonreligious people in the study had better mental health than the marginally religious spiritual people, so the psychological benefits of religion don’t tell the whole story. While more research needs to be done, some possible explanations include:

References:

  1. Castella, T. D. (2013, March 01). Spiritual, but not religious. BBC News. Retrieved from http://www.bbc.co.uk/news/magazine-20888141
  2. Corner, D. (2006). The impact of spirituality on mental health: A review of the literature[PDF]. London: The Mental Health Foundation.
  3. Gallup, G. H., Jr. (2003, February 11). Americans’ spiritual searches turn inward. Gallup. Retrieved from http://www.gallup.com/poll/7759/americans-spiritual-searches-turn-inward.aspx
  4. Merica, D. (2013, January 9). The spiritual but not religious likely to face mental health issues, drug use, study says. CNN Belief Blog RSS. Retrieved from http://religion.blogs.cnn.com/2013/01/09/the-spiritual-but-not-religious-likely-to-face-mental-health-issues-drug-use-study-says/
  5. Newport, F. (2011, June 3). More than 9 in 10 Americans continue to believe in God. Gallup. Retrieved from http://www.gallup.com/poll/147887/americans-continue-believe-god.aspx
  6. Spirituality ‘link’ to mental illness. (2013, January 2). PubMed Health. Retrieved from http://www.ncbi.nlm.nih.gov/pubmedhealth/behindtheheadlines/news/2013-01-02-spirituality-link-to-mental-illness-/

Hands resting on prison barsAlthough jail time might seem like a distant possibility for most people, incarceration rates in the United States are steadily rising. One study published in the journal Pediatrics found that 41% of young adults have been arrested by the time they are 23. The U.S. Department of Justice (DOJ) reports that 6.6% of people serve time in prison at some point in their lives, and the statistic rises to a shocking 32% for African-American men. More than half of inmates are diagnosed with a mental health disorder.

As state mental hospitals continue to close and mental health services remain financially out of reach for many people, this number may rise. Moreover, prison itself can exacerbate preexisting mental health issues and create new mental health challenges among those who had never experienced them.

Mental Health Care Behind Bars

Jails and prisons are required to provide basic health care for inmates, but the quality of this care varies greatly. Often, prison-based mental health care focuses on stabilizing, rather than treating, inmates. A person experiencing hallucinations or psychosis might get medication to control the most severe symptoms, but people with anxiety issues, depression, posttraumatic stress, and other mental health conditions that don’t cause radical changes in behavior may go untreated. Prisoners rarely, if ever, get therapy or comprehensive treatment, so mental health issues that were previously controlled with medication and therapy may get much worse during incarceration.

Prison and Trauma

Even for the most hardened criminals, prison can be a scary place. The DOJ reports that 70,000 prisoners are sexually abused every year, and assaults, fights, and other acts of violence are common in a prison setting. But violence isn’t limited to inmates; prison guards work in a high-stress environment that can increase their likelihood of becoming violent. With little hope for reporting abuse by guards, some inmates may endure verbal abuse, threats of physical violence, and even severe attacks. Women inmates are at an increased risk of being sexually assaulted by jail and prison guards. This ongoing climate of trauma can create anxiety, depression, phobias, and PTSD in prisoners who previously had no serious mental health issues.

Lack of Support

Prisoners are, by definition, cut off from the rest of society, and their access to supportive friends and family may be limited. Many jails have instituted mail policies prohibiting letters and magazine subscriptions, and these policies can eliminate prisoners’ ability to communicate with and receive support from loved ones. Phone calls from jail can be costly, and prisoners from impoverished backgrounds may have families who can’t afford to cover the costs of collect calls, however infrequent. There’s little hope for getting any support in prison, as many prisoners are concerned more with gaining respect and avoiding fights in a relentless pursuit of safety. Support from loved ones can play a critical role in helping people overcome mental challenges, and isolation can increase a person’s risk of mental health issues such as depression and anxiety.

Getting Out

Most prisoners have ignored basic rules of society, so it can be difficult for prisoner rights issues to garner much public sympathy. But many prisoners are incarcerated for nonviolent drug crimes that are the result of substance addiction. And even inmates incarcerated for violent crimes do not typically serve life sentences. Most prisoners are ultimately released, and the mental health issues they develop in prison can increase their risk of reoffending and make it difficult to reenter society as a productive, nonthreatening citizen. Almost 70% of people who have been incarcerated are arrested again within three years, and the dire state of mental health care in prisons could play a significant role in this high rate of recidivism.

A mental health professional can help people who have come into contact with the prison system. A therapist can help prisoners reenter society or reestablish bonds with friends and family. Loved ones of incarcerated individuals can also get necessary emotional support in therapy. Therapy is a safe and confidential place for any and all people to get help.

References:

  1. Chaddock, G. R. (2003, August 18). US notches world’s highest incarceration rate. The Christian Science Monitor. Retrieved from http://www.csmonitor.com/2003/0818/p02s01-usju.html
  2. Gann, C. (2011, December 19). Study: Significant number of young Americans get arrested. ABC News. Retrieved from http://abcnews.go.com/Health/arrests-increasing-us-youth/story?id=15180222
  3. James, D. J., & Glaze, L. E. (2006, December 14). Mental health problems of prison and jail inmates [PDF]. Washington, D.C.: U.S. Department of Justice Bureau of Justice Statistics.
  4. Purdy, M. (1995, December 19). Brutality behind bars. The New York Times. Retrieved from http://www.nytimes.com/1995/12/19/nyregion/brutality-behind-bars-special-report-prison-s-violent-culture-enveloping-its.html?pagewanted=all
  5. Recidivism. (n.d.). Bureau of Justice Statistics (BJS). Retrieved from http://bjs.ojp.usdoj.gov/index.cfm?ty=tp
  6. Sakala, L. (2013, February 7). Return to sender: Postcard-only mail policies in jails. Prison Policy Initiative. Retrieved from http://www.prisonpolicy.org/postcards/report.html
  7. U.S.: Federal justie statistics show widespread prison rape. (2007, December 16). Human Rights Watch. Retrieved from http://www.hrw.org/news/2007/12/15/us-federal-statistics-show-widespread-prison-rape
  8. U.S.: Number of mentally ill in prisons quadrupled. (2006, September 6). Human Rights Watch. Retrieved from http://www.hrw.org/news/2006/09/05/us-number-mentally-ill-prisons-quadrupled

Steroid needle on a trackIn a highly anticipated interview with Oprah Winfrey, famed cyclist Lance Armstrong has finally come clean about the allegations of doping that have haunted him for much of his unparalleled career. Armstrong, who in August 2012 was stripped of his record seven Tour de France victories and banned from competitive cycling due to mounting evidence of performance-enhancing drug use, is just one in a long line of athletes—most notably baseball players—who have either confessed to using performance enhancers or whose images have been tarnished by credible allegations of doping.

It’s no secret that many athletes will go to any length for a competitive edge, but performance-enhancing drugs carry numerous health risks, including baldness, impotence, infertility, addiction, psychiatric issues, hypertension, liver problems, and numerous other issues.

In a world where athletes who use performance-enhancing drugs always seem to get caught, often with disastrous consequences for their careers, what would compel an athlete to risk not only his or her health but livelihood as well?

Perfectionism and Pressure to Perform
Competitive sports can be cutthroat. Fans, coaches, and sponsors have high expectations for athletes, and hold in high regard records and never-been-done-before, seemingly superhuman feats. These expectations are frequently unrealistic, but can place considerable pressure on athletes. People in the upper echelons of athletics are often perfectionists to begin with; after all, it’s not easy to make it to the top. These perfectionist tendencies can make performance-enhancing drugs seem not only justified, but necessary.

Particularly when the competition uses performance-enhancing drugs, a dedicated athlete might feel like he or she has no choice. If the competition has an unfair advantage, taking drugs may seem less like cheating and more like leveling the playing field.

Peer Pressure
Particularly as more and more athletes admit to the use of performance-enhancing drugs, it can seem like sport is full of doping. Athletes may experience peer pressure from friends, teammates, and coaches, who may suggest that they can’t keep up with their competitors if they don’t use drugs. Peer pressure can also come in indirect ways. When athletes are criticized by peers, they might feel like their only hope for improvement can come in a vial or pill. Coaches, teammates, and even physicians or trainers may be complicit in doping.

Financial Issues
Not all athletes are wealthy. Particularly among Olympic athletes, financial gain often comes in the form of sponsorships, not from the sport or league. Many athletes spend years paying coaches, trainers, and gyms, and may get deep in debt covering the costs of developing into one of the best at what they do. Athletes are much more likely to get cushy sponsorship deals and contracts when they break records or win competitions. Particularly when an athlete knows or believes that other successful people in his or her field are using performance-enhancing drugs, they might seem like the most attractive or likely way to get out of debt and into financial security.

Secrecy
Although many athletes are regularly drug-tested, dopers try to stay one step ahead of the science. Many athletes have devised novel ways to avoid being caught, and in a high-stakes world, it’s easy to believe you can outsmart the testing mechanisms. Indeed, many athletes have managed to do just that for years, so the risk might seem worth it to an athlete under immense pressure.

References:

  1. Oprah: Lance Armstrong confesses. (2013, January 16). ESPN. Retrieved from http://espn.go.com/sports/endurance/story/_/id/8845599/oprah-winfrey-confirms-lance-armstrong-admitted-doping
  2. Performance-enhancing drugs: Know the risks. (2012, December 12). Mayo Clinic. Retrieved from http://www.mayoclinic.com/health/performance-enhancing-drugs/HQ01105
  3. Shermer, M. (2008, March 31). The doping dilemma. Scientific American. Retrieved from http://www.scientificamerican.com/article.cfm?id=the-doping-dilemma
  4. Shermer, M. (2009, September 07). Why athletes dope. The Huffington Post. Retrieved from http://www.huffingtonpost.com/michael-shermer/why-athletes-dope_b_278861.html

People who are discriminated against cope with that discrimination in various ways. Although some cope adaptively and use strategies that are constructive and empowering when they are faced with adversity, others turn to maladaptive coping mechanisms. One such mechanism is the use and abuse of alcohol and drugs. Racial discrimination has been shown to be related to increased drug and alcohol use, but has not been proven to be the cause of the increase. So why is it that some people use alcohol and drugs to cope while others do not? Meg Gerrard of the Norris Cotton Cancer Center at Dartmouth Medical School in New Hampshire wanted to explore this question further. In a recent study, Gerrard looked at whether people used drugs/alcohol as a method of coping consistent with their habitual coping strategies, or if they believed that substance use would decrease their feelings of stress and negativity stemming from the discrimination.

Gerrard conducted three separate studies designed to elicit feelings of discrimination among a sample of African-American adolescents. In her third study, she followed the level of substance use for eight years to determine the long-term influence of the discrimination-use relationship. She found that the participants who felt that substance use was an acceptable way to cope with problems were more likely to use drugs/alcohol when they felt discriminated against than those who did not endorse substance use. Over time, the results revealed that those who did support substance use as a method of coping continued to use drugs/alcohol throughout adolescence and into early adulthood, while those who never supported this belief did not. These findings suggest that adopting substance-use behaviors early on can lead to long-term maladaptive coping strategies for some individuals.

The findings from this study were gathered only from African-American participants. Future work should look at the coping-discrimination dynamic among other minority individuals, as evidence exists that prejudice and discrimination increases stress across all ethnicities. Gerrard noted that one domain that was not examined in her study was the effect of parental support. When parents teach their children how to handle stressful situations prior to their occurrence, children have a better chance of dealing with challenges such as discrimination in productive and adaptive ways rather than trying to relieve the stress with drugs or alcohol. Research should explore the buffering effects that family and parental support can have on this segment of the population. Until then, these studies demonstrate that acceptance of maladaptive coping strategies can increase negative behavior in people facing discrimination. “The current studies also provide evidence that use-as-coping is not caused by discrimination—instead, it increases the relation between discrimination and subsequent substance use,” Gerrard said.

Reference:
Gerrard, Meg, Michelle L. Stock, Megan E. Roberts, Frederick X. Gibbons, Ross E. O’Hara, Chih-Yuan Weng, and Thomas A. Wills. Coping with racial discrimination: The role of substance use. Psychology of Addictive Behaviors 26.3 (2012): 550-60. Print.

Yelling sports fan with face paint

Sports generally are viewed as harmless pursuits, a source of social interaction and bonding, exercise, and stress relief. But in recent years, highly publicized incidents of fan violence have raised concerns about the culture surrounding sports. The vicious 2011 beating attack on Bryan Stow at Dodger Stadium in Los Angeles is just one such example. Alcohol-fueled fights and skirmishes are increasingly common at all levels of competition, from playgrounds to professional leagues. Most people who have attended a sporting event have witnessed at least one example of an out-of-control fan.

What’s behind this surge in violence? The problem may not be the nature of sports themselves, but rather the way society treats sports in conjunction with personal factors. A closer look at some factors that may contribute to fan violence:

Overidentification

For many sports fans, their teams of choice become a proxy for their own identities. Overidentifying personally with a favorite team may be a contributing factor to sports violence. A person who watches a favorite team lose, or witnesses an unfavorable referee call, may behave as if he or she has personally suffered. The advent of Facebook and other social media, as well as message boards and other gathering places for fans, may make it difficult to disengage from favorite teams or let go of bad memories. These platforms also provide more access to inflammatory views from rival teams’ fans, fueling deep feelings of loyalty, protectiveness, and anger that boil to the surface amid the emotional current of a live game.

Alcohol

Alcohol plays a significant role in many fan altercations. At National Football League games in 2011, more than 7,000 fans were ejected for inappropriate or violent behavior. Some fans spend all morning and afternoon tailgating and drinking with friends before watching the event and then celebrating—or grieving—afterward. People often are intoxicated before even entering a venue. The feelings of deep loyalty and anger that many fans feel can be exacerbated by alcohol consumption.

Hypermasculine Culture

Despite years of progress toward gender equality, many men feel pressured to meet expectations of traditionally masculine behavior. Sports can be a significant platform for masculine identity, and people who identify with hypermasculine culture may be more likely to attend sports events. Combined with adrenaline, overidentification, and ready access to fans with opposing allegiances, some men may be inclined to be violent when exposed to triggers. Likewise, women in hypermasculine environments that promote disrespectful or violent behavior may also be more inclined to engage in it.

Sociological Factors

Certain people are at a greater risk of engaging in violent behavior. People who have experienced a recent stress such as job loss, the death of a loved one, or a perceived humiliation are already on edge and more likely to react emotionally. Many people attend sporting events to alleviate stress. However, when a favored team loses, a person is heckled, or a person loses a significant bet associated with a game’s outcome, stress may explode into rage.

Group Dynamics

Millions of people attend sporting events every year, and the vast majority never commit a violent act. When 100,000 people pack a stadium, though, the odds are high that a number of them are under the influence of alcohol. Combine this with an emotional, hypermasculine environment and exposure to opposing sentiment, and you’ve created a recipe for fan violence. Proactive measures such as reporting inappropriate behavior immediately, limiting alcohol intake, and actively encouraging sportsmanship among peer groups, can help address an increasingly challenging threat to our enjoyment of sporting events.

References:

  1. Aguirre, B. E. (2008). Sports fan violence in North America. Contemporary Sociology: A Journal of Reviews, 37(2), 157-158. doi: 10.1177/009430610803700235
  2. Associated Press. (2012, May 31). Witnesses describe violent scene. ESPN. Retrieved from http://espn.go.com/los-angeles/mlb/story/_/id/7991565/witnesses-depict-violent-scene-bryan-stow-beating
  3. Handwerk, B. (n.d.). Sports riots: The psychology of fan mayhem. National Geographic. Retrieved from http://news.nationalgeographic.com/news/2005/06/0620_050620_sportsriots.html

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