For those of us who got off addictions the old-fashioned way, reports from the recent American Psychiatric Association‘s annual meeting sound like good news, even if it’s a little late in coming. AP Medical writer Lauran Neergaard summed up the latest:
“This is the next frontier in substance abuse: Better understanding of how addiction overlaps with other brain diseases is sparking a hunt to see if a treatment for one might also help another.
We’re not talking about attempts just to temporarily block an addict’s high. Today’s goal is to change the underlying brain circuitry that leaves substance abusers prone to relapse.
It’s “a different way of looking at mental illnesses, including substance abuse disorders,” says National Institute on Drug Abuse Director Dr. Nora Volkow, who on Monday urged researchers at the American Psychiatric Association’s annual meeting to get more creative in the quest for brain-changing therapies for addiction.
Rather than a problem in a single brain region, scientists increasingly believe that psychiatric diseases are a result of dysfunctioning circuits spread over multiple regions, leaving them unable to properly communicate and work together. That disrupts, for example, the balance between impulsivity and self-control that plays a crucial role in addiction.
Addiction is a strange phenomenon, and we who know a lot about it (this writer kicked cigarettes in the 60s, alcohol in the 80s, crunching ice — you haven’t ever met an ice-crunching addict? Believe it. — five or six years ago) say it’s about time we got our own dysfunctional circuitry studies.
Think of it as if the brain were an orchestra, its circuits the violins and the piano and the brass section, all smoothly starting and stopping their parts on cue, Volkow told The Associated Press.
“That orchestration is disrupted in psychiatric illness,” she explains. “There’s not a psychiatric disease that owns one particular circuit.”
So NIDA, part of the National Institutes of Health, is calling for more research into treatments that could target circuits involved with cognitive control, better decision-making and resistance to impulses.
Addictive behavior has drawn attention from researchers and writers for years. A 1983 study done for the National Academy of Sciences by Alan R. Lang, Professor of Psychology at Florida State University reported that “some mental health experts find it useful to view addiction as including all self-destructive, compulsive behaviors” and cited references to addictions as wide-ranging as caffeine (guilty), chocolate (definitely) and gambling (not on your life.)
Changing behaviors to conquer addictions, with a little help from therapies and therapists of all sorts, has been plugging along as a solution for decades. Takes a lot of work. Wouldn’t a magic pill be lovely?
The main character, a woman of a certain age, became concerned about suddenly being short of breath. Nine months earlier she had defended her title in a 5k community road race, so it didn’t seem to make sense that she would be huffing and puffing after one block on a slight incline. She worried more and more, and finally went to see her primary care physician.
“No,” said the doctor, “this should not be. We’ll start with a stress test to check out the heart, and then go with a pulmonary function test. Recent x-rays haven’t shown anything wrong with your lungs, but we’ll want to make sure.”
The patient aced the stress test, which relieved everyone. Subsequently, at the end of the pulmonary function tests she did the six-minute walk, as instructed, regular pace, and the nurse who had been following along in case she conked out said, “Well, you’ve got no shortness of breath, and I’m exhausted.”
In between, an interesting thing had happened. During a visit with her niece, who is a family practice physician in another state, the medical dilemma happened to come up. “Well,” said the niece, rather gently, “you’re doing all the right things: seeing your doctor, having a stress test first, checking pulmonary function. But when all is said and done you did just lose a sister to respiratory failure, while you were still grieving the loss of another sister almost within the same year… It could be that your body is just trying to tell you something.”
Almost immediately I felt better. Went ahead with the pulmonary function test just to err on the side of caution, but by then I was feeling so much better that just walking around that hospital corridor at what felt a leisurely pace was still enough to wear out a nurse who is 10 years younger. She hadn’t told me she was required to follow. And of course, at the start of it all, I hadn’t thought to mention anything about sibling loss to my primary care doctor. Communication is good.
Soon afterwards, I attended a meeting at which the keynote speaker was Lyn Prashant, founder of an organization called Degriefing. Among the handouts was a page headed “Common Grief Reactions,” featuring lists of physical, emotional and mental responses to grief. Number 5 under Physical? You guessed it: shortness of breath.
Who knew? Certainly not this writer, who has only spent the past three decades intensely involved with end-of-life issues. Hospice volunteer, part of an AIDS support group throughout the 1990s, currently a chapter board member and client volunteer for Compassion and Choices, author of dozens of articles and one book about end-of-life issues. Never heard of any of those physical manifestations of grief — or if I had, they were too abstract to register.
That was then, this is now: Loss, sorrow, grief — is it all in your head? Maybe not.
“It’s ADHD, that’s what I have,” my friend Ann told me some years ago. She made the announcement with a combination of enthusiasm and relief, as if getting diagnosed with ADHD were the beginning of the end of years of anxiety and frustration — which, in fact, it was.
I had never heard of such a thing. I did know Ann was remarkably creative, that she often jumped from one idea to another, lost her house keys with regularity, frequently left things undone, pushed herself to achieve and was famous for juggling three or four projects at once. By now, almost everyone in the country knows someone (or is someone) with a similar combination of traits, and almost everyone has heard of ADHD.
The symptoms of adult attention-deficit hyperactivity disorder seem to describe half the people in New York City (and elsewhere): restlessness, impatience, impulsivity, procrastination, chronic lateness, and difficulty getting organized, focusing and finishing tasks.
How do you know you have ADHD, which experts compare to having a mind like a pinball, with thoughts flitting in multiple directions. Maybe you’re just overcaffeinated and overworked? And if you do have it, will there be a stigma? Should you try medication? Will it work?
Parents of children with suspected ADHD face a myriad of similar questions. But the concerns can be just as troubling for adults, whose ADHD often goes unrecognized.
An estimated 8% of U.S. children have ADHD, which is also known as ADD, for attention-deficit disorder, and some 50% of them outgrow it, according to government data. About 4.4% of U.S. adults—some 10 million people—also have ADHD and less than one-quarter of them are aware of it.
That’s because while ADHD always starts in childhood, according to official diagnostic criteria, many adults with the disorder went unnoticed when they were young. And it’s only been since the 1980s that therapists even recognized the disorder could persist in adults.
Even now, getting an accurate diagnosis is tricky. Some experts think that too many adults—and children—are being put on medications for ADHD, often by doctors with little experience with the disorder. Others think that many more people could benefit from ADHD drugs and behavioral therapy.
Ann considers herself one of the lucky ones. She was diagnosed relatively early (although the disorder undoubtedly caused a long list of problems that might well have been avoided) and settled into a drug regimen that has made life greatly more livable for decades. It does not appear she had other problems that often accompany ADHD, as Wall Street Journal health writer Melinda Beck explains in an informative ‘Personal Journal’ article this week.
Complicating the picture further, ADHD frequently goes hand in hand with depression, anxiety and bipolar disorder, and it can be difficult to untangle which came first. “It’s very common for someone to be treated for depression or anxiety for years, and have the therapist not notice the ADHD,” says Mary Solanto, director of the AD/HD Center at the Mount Sinai Medical Center in New York City. But adults whose ADHD is left untreated face a high incidence of substance abuse, automobile accidents, difficultly staying employed and maintaining relationships.
That said, some adults with ADHD are highly intelligent, energetic, charismatic and creative, and are able to focus intently on a narrow range of topics that interest them. David Neeleman, the founder of JetBlue Airways, and Paul Orfalea, founder of Kinko’s, have spoken out about how the disorder helped them come up with innovative ideas for their corporations, despite their having done poorly in school.
“It’s amazing how successful some people are able to be despite these symptoms, and some people are totally paralyzed—there’s a whole spectrum of outcomes,” says Ivan K. Goldberg, a psychiatrist in New York City who co-developed a commonly used screening test.
Generally, ADHD can make life very difficult. It’s thought to be an imbalance in neurotransmitters, the chemical messengers that relay signals in the brain, particularly in the frontal cortex that governs planning and impulse control. Children with the disorder, particularly boys, are likely to be hyperactive, with an intense need to move constantly, which can interfere with learning. (Girls tend to be talkative and dreamy, but they are often overlooked because they aren’t as disruptive.)
Adults more typically have trouble with paying attention, focusing and prioritizing. Managing time and money are particularly difficult.
“What it really is is a disturbance of the executive functions of the brain — it’s the inability to plan things, to initiate them at the appropriate time, not to skip any of the steps and to terminate them at the appropriate time,” says Dr. Goldberg. “An awful lot of these people are very bright but they can’t keep it together. They keep screwing things up.”
It’s that last line that gets the attention of us all. Some of us screw things up more often than others — and wonder if we could blame it on ADHD. Identifying, and treating, those who can is a bright-spot possibility of the future.
Most of us know the feeling — a mom, a friend, a neighbor who’d seemed just a little spacey for the last few months has taken up residence in a “memory unit.” And some of us (OK, I’m older than you are, so you can relax now) stuff that sorrowful feeling down inside, right next to the fear that arose over where in the world I put the car keys.
Maybe we should all relax. Because anxieties can make you forget even more, and research shows that “buying into the stereotype that memory function automatically dwindles with age could become a self-fulfilling prophecy,” according to reports just published on a new favorite health/science website of mine, RealAge.com.
At least that’s what happened in one study. When older adults (ages 60 to 70 years) were given cues that people their age tend to suffer from memory loss, they actually performed more poorly on memory tests than a control group not exposed to such cues. Likewise, older adults who felt looked down upon — or stigmatized — due to age also fared poorly on memory tests. Bottom line: Anxious thoughts about negative stereotypes may disrupt your working memory. So think positive!
The site is a new favorite partly because it has a “Find your real age” thing which determined that I am younger than 76.5 and why should one argue. RealAge does concede that positive thinking will not guarantee memory retention, but then plunges right ahead with other suggestions. Such as staying in touch with family and friends:
In a study of 16,638 older adults, people who were married, active in volunteer groups, and in regular contact with friends, family, and neighbors had slower declines in memory than their less social counterparts. In fact, declines in the most socially active types were about half of those in the least social group.
Or eating the right stuff: fish, nuts, real chocolate!; or walking a lot; or, and here’s the winner, taking power naps:
People who take daytime naps outperform non-nappers on memory exercises. And, surprisingly, a mere 6 minutes of shut-eye is enough to refresh the mind. How does a quick catnap power up your thinker? Seems the mere act of falling asleep triggers a brain-boosting neurobiological process that remains effective regardless of how long you snooze.
What’s not to love about a resource that advises hanging out with friends, eating almonds and chocolate and taking power naps? Now, if there were just something in there about where I put the keys…
The photo on the front page of the Sunday New York Times tells the ultimate underside to holiday joy: a young woman, Sarah Walton, with her arms around the tombstone of her husband. The scene is in Arlington cemetery; the simple stone reads LTC James J. Walton and lists the parameters of his brief life, 1967-2008.
In households and hotel rooms everywhere, sadness and loss color the holidays gray. Most of the sadness is of a far lesser sort than that of the grieving widow, but just as real: relationships gone sour, bills that can’t be paid, health that can’t be restored — or the old, familiar pains of too many demands and too little time.
At my San Francisco church, a ‘Blue Christmas’ service was started four years ago by Associate Pastor Catherine Oliver, designed for those who struggle under the weight of everyone else’s festive spirits. Some of the faces she sees are familiar, but many belong to strangers seeking comfort or relief. This year, Oliver reports, attendance was not notably higher — “but there were more men.”
Acknowledging the stress and depression that so often accompany the Thanksgiving-to-New Year’s Day season, the Mayo Clinic recently posted a few tips to help bring a little peace and joy into the season. They are summarized here, in categories found to be common.
First, Mayo Clinic recommends, recognize holiday triggers so you can disarm them before meltdown occurs. Most common among these are:
Relationships. Relationships can cause turmoil, conflict or stress at any time, but tensions are often heightened during the holidays. Family misunderstandings and conflicts can intensify — especially if you’re thrust together for several days. On the other hand, facing the holidays without a loved one can be tough and leave you feeling lonely and sad.
Finances. With the added expenses of gifts, travel, food and entertainment, the holidays can put a strain on your budget — and your peace of mind. Not to mention that overspending now can mean financial worries for months to come.
Physical demands. Even die-hard holiday enthusiasts may find that the extra shopping and socializing can leave them wiped out. Being exhausted increases your stress, creating a vicious cycle. Exercise and sleep — good antidotes for stress and fatigue — may take a back seat to chores and errands. To top it off, burning the wick at both ends makes you more susceptible to colds and other unwelcome guests.
The good news is that even with the worst of causes, holiday blues can be lessened. Most effectively by following a few good recommendations such as these:
Acknowledge your feelings. If someone close to you has recently died or you can’t be with loved ones, realize that it’s normal to feel sadness and grief. It’s OK to take time to cry or express your feelings. You can’t force yourself to be happy just because it’s the holiday season.
Reach out. If you feel lonely or isolated, seek out community, religious or other social events. They can offer support and companionship. Volunteering your time to help others also is a good way to lift your spirits and broaden your friendships.
Be realistic. The holidays don’t have to be perfect or just like last year. As families change and grow, traditions and rituals often change as well. Choose a few to hold on to, and be open to creating new ones. For example, if your adult children can’t come to your house, find new ways to celebrate together, such as sharing pictures, emails or videotapes.
Set aside differences. Try to accept family members and friends as they are, even if they don’t live up to all your expectations. Set aside grievances until a more appropriate time for discussion. And be understanding if others get upset or distressed when something goes awry. Chances are they’re feeling the effects of holiday stress and depression too.
Stick to a budget. Before you go gift and food shopping, decide how much money you can afford to spend. Then stick to your budget. Don’t try to buy happiness with an avalanche of gifts. Try these alternatives: Donate to a charity in someone’s name, give homemade gifts or start a family gift exchange.
Plan ahead. Set aside specific days for shopping, baking, visiting friends and other activities. Plan your menus and then make your shopping list. That’ll help prevent last-minute scrambling to buy forgotten ingredients. And make sure to line up help for party prep and cleanup.
Learn to say no. Saying yes when you should say no can leave you feeling resentful and overwhelmed. Friends and colleagues will understand if you can’t participate in every project or activity. If it’s not possible to say no when your boss asks you to work overtime, try to remove something else from your agenda to make up for the lost time.
Don’t abandon healthy habits. Don’t let the holidays become a free-for-all. Overindulgence only adds to your stress and guilt. Have a healthy snack before holiday parties so that you don’t go overboard on sweets, cheese or drinks. Continue to get plenty of sleep and physical activity.
Take a breather. Make some time for yourself. Spending just 15 minutes alone, without distractions, may refresh you enough to handle everything you need to do. Take a walk at night and stargaze. Listen to soothing music. Find something that reduces stress by clearing your mind, slowing your breathing and restoring inner calm.
Seek professional help if you need it. Despite your best efforts, you may find yourself feeling persistently sad or anxious, plagued by physical complaints, unable to sleep, irritable and hopeless, and unable to face routine chores. If these feelings last for a while, talk to your doctor or a mental health professional.
None of the above can bring back a loved one, or make a new job appear. But perhaps they can help you through to a better and brighter New Year.