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Archive for the ‘Other Disorders/Addictions’ Category

Boredom Management

Tuesday, April 21st, 2009

Form 4E

Boredom Management

Optional Exercise

For many people who use marijuana, boredom is a trigger to smoke. Sometimes it is boredom associated with a tedious or uninteresting job. Perhaps it is a way to fill weekday evening hours after dinner but before bedtime. At other times, getting stoned is a way to spend a weekend when nothing else has been planned.

Boredom is a complex and interesting emotion. Many different feelings may be associated with it. For instance, boredom may be accompanied by anxiety, apathy, irritability, or lethargy. It’s not a really strong emotion; it just kind of nags at you. It can sneak up because it’s hard to identify.

Discussing boredom and how to handle it can make you aware of its influence on your behavior and prepare you to cope with it.

A Boring Story

Jan was in her mid-30s when she began to think she needed to quit smoking pot. Sometimes she enjoyed it, but after 15 years of regular use Jan was unhappy with herself for smoking so much marijuana. She began every day with a hit and smoked every hour or two throughout the day.

Several times in the past few years she had tried to cut back to smoking just in the evenings and on weekends. A few times she kept to her limits, but inevitably she’d inch her way back up. When she thought about it, she recognized that she slipped back to getting stoned because she couldn’t handle the boredom she felt when she was straight. Her job wasn’t stimulating; she was a receptionist in a travel agency. When she tried to get through a day without smoking, the tedium of her job got to her.

Now as she thought about quitting pot completely, she couldn’t imagine how she’d cope with being bored at work. On top of that, she was sure that the evenings and weekends would be miserable if she didn’t get high. Being bored was torture for Jan. Boredom was an endless emptiness and an inner void, with unpleasant restlessness and anxiety. She wondered whether she had a chance of quitting marijuana.

Jan lived by herself and liked it that way. She had two close friends and worried about how these friendships would be affected if she stopped getting high. She feared that her being straight would alienate at least one friend. With fewer friends, boredom would be even worse!

1. What does boredom feel like to you?

2. Is it always a miserable experience?

3. What makes boredom so uncomfortable?

4. How would you cope with being bored if you were Jan?

HIV and Confidentiality

Thursday, April 16th, 2009

HIV and Confidentiality

Almost all States now have laws protecting information about individuals’ HIV status. The laws vary widely in the strength of the protection they offer. All allow for disclosure of HIV related information in certain circumstances. Administrators should educate themselves about the HIV confidentiality protections offered by their individual States.

Discrimination Against LGBT Individuals

In much of the United States, discrimination against individuals because of their sexual orientation is legal. Although some States have extended their laws against racial and gender discrimination to cover discrimination on the basis of sexual orientation, in most places LGBT individuals can be denied employment or fired, barred from housing, and excluded from health and social services.

LGBT individuals are disadvantaged legally in other areas as well. In most States, same-sex couples in a committed relationship are prohibited from marrying. This means that same-sex partners must make special arrangements if they wish to bequeath their assets to each other after death. Few jurisdictions provide unmarried partners of employees the health insurance benefits married partners take for granted; even fewer require private employers to offer unmarried partners these benefits. Partners may have difficulty visiting their loved ones in hospitals that have “family only” policies. LGBT individuals are often denied the right to adopt children.

Because of the lack of protection under the law, LGBT individuals may suffer severe or painful consequences if their sexual orientation becomes known. They risk losing custody of their own children in disputes with former spouses or families of origin because of their sexual orientation. (A diagnosis of substance abuse can be yet another strike against them in such cases.) In addition, LGBT individuals can be discharged from the military if their sexual orientation becomes known.

Thus far, only one State has enacted legislation that recognizes what it terms “civil union” between two individuals of the same sex. The statute was passed in response to a decision of the Supreme Court of Vermont (Baker v. State of Vermont) finding that the State’s denial of marriage licenses to same-sex couples “effectively excludes them from abroad array of legal benefits and protections incident to the marital relation, including access to a spouse’s medical, life, and disability insurance, hospital visitation and other medical decision making privileges, spousal support, intestate succession, homestead protections, and many other statutory protections.” The court held that “the State is constitutionally required to extend to same-sex couples the common benefits and protections that flow from marriage under Vermont law.”

The Vermont Supreme Court did not order the State to offer marriage licenses to same-sex couples. Rather it required the State legislature to “craft an appropriate means of addressing this constitutional mandate [through any one] potentially constitutional statutory scheme from other jurisdictions [that provide] an alternative legal status to marriage for same- sex couples, impose similar formal requirements and limitations, create a parallel licensing or registration scheme, and extend all or most of the same rights and obligations provided by the law to married partners.” Ultimately, the State legislature chose to enact a “civil union” (cu) statute, and same-sex couples in Vermont have already been “cu’ed.” (It remains unclear whether other States will recognize such unions between individuals who travel to Vermont for the purpose of being cu’ed.)

The Vermont Supreme Court based its decision squarely on the common benefits clause of the Vermont constitution, a provision it interpreted as offering stronger protection to Vermont citizens than the Federal equal protection clause. The advantage of the court’s resting its decision on the Vermont constitution is that the U.S. Supreme Court cannot review or overturn the decision. The disadvantage is that other States lacking a similar clause are less likely to adopt the court’s reasoning.

For up-to-date information on the laws regarding discrimination against LGBT individuals, see

Perspectives on Homosexuality

Thursday, February 19th, 2009

Homosexuality, as a specific category, was not described in the medical or psychiatric literature until the early 1870s. The fledgling psychoanalytic movement regarded homosexuality as a topic of special interest. Sigmund Freud believed a person’s sexual orientation, in and of itself, did not impair his or her judgment or cause problems, and Freud set a positive tone when he supported homosexual colleagues in medical and psychiatric societies. Even so, European psychoanalytic organizations did not welcome gay men and lesbians as members in the early years of psychiatry, and many American psychiatrists and psychoanalysts promoted the attitude that homosexuality was a mental disorder.
Bieber and colleagues (1962) proposed that childhood influences and family upbringing were responsible for producing male homosexuality and described the classic combination of a distant, uninvolved father and an overinvolved mother. They did not consider biology or genetics as playing a role. Other psychoanalytic writing also refuted a biological component to female homosexuality, seeing it as caused primarily by early developmental disturbances.
Alfred Kinsey introduced new perspectives on homosexuality with his studies of sexual behavior (Kinsey, Pomeron & Martin, 1948; Kinsey et al., 1953). Although his studies have been criticized for a variety of reasons, such as poor sampling methods, the studies greatly increased Americans’ awareness of sexuality and the range of sexual behavior.
The psychologist Evelyn Hooker (1957) demonstrated that no discernible differences existed between the psychological profiles of gay men and those of heterosexual men, effectively beginning the debunking of the theory that homosexuality is a mental illness. Psychiatrist Judd Marmor (1980) recognized that homosexuality could not be explained in a single dimension and helped support exploring the biological, genetic, psychological, familial, and social factors involved in the formation and expression of a homosexual orientation.
In 1973, the American Psychiatric Association, after extensive scientific review and debate, stopped classifying homosexuality as a mental illness. Homosexuality is now seen as a normal variation of human sexual and emotional expression, allowing, it is hoped, a nonpathological and nonprejudicial view of homosexuality as well as of LGBT people. LGBT people and homosexual and bisexual behavior are found in almost all societies and cultures in the world and throughout history (Herdt, 1996). But the degree of tolerance and acceptance of them has varied considerably in different periods of history and from country to country, culture to culture, and community to community. Anthropological studies that have observed homosexual behavior in other cultures may help put homosexuality in global perspective and may contribute to understanding some of the issues facing American LGBT individuals who are from ethnic or cultural minority groups, such as African Americans (Jones & Hill, 1996), Asian Americans (Nakajima, Chan & Lee, 1996), Latinos/ Latinas/Hispanics (Gonzalez & Espin, 1996), and Native Americans (Tafoya, 1996).
The genetic and biological contributions to sexual orientation have been studied increasingly in recent years. Unfortunately, the biological studies often grow out of the confusion between sexual orientation and gender identity. Many studies have tried to demonstrate that physical traits in gay men resemble those of women or have tried to identify traits in lesbians that resemble those of males. These views are based on the belief that, if a man wishes to be with a man, he must somehow be like a woman, and a woman wishing to be with a woman must, in some way, be like a man.
The Kinsey Institute has supported surveys and studies of both sexual behavior and sexual orientation and concluded that homosexuality must be innate, that is, inborn, and is not influenced developmentally by family upbringing (Bell & Weinberg, 1978; Bell, Weinberg & Hammersmith, 1981; Weinberg & Williams, 1974). The studies noted the diversity and variety of gay men and lesbians, recognizing that there was no uniform way to be or become gay or lesbian in our society.
Lesbianism and female homosexuality have also been studied from a nonpathological perspective. Magee and Miller (1998) reviewed these efforts and found no psychodynamic etiologies to female homosexuality and that each lesbian is unique and without stereotypic characteristics.
Studies of intersexual people, that is, people with sexually ambiguous genitalia or true hermaphrodites, are often analyzed. Hermaphrodites have both male and female reproductive organs. These studies ultimately are about gender role expectations and do not contribute to our understanding of homosexuality.

The most promising areas of study involve genetics and familial patterns. Although the gene has not been identified, Hamer and Copeland (1994) have reported a linkage on the X chromosome that may influence homosexual orientation. The genetic and familial patterns studied by Pillard, Bailey, and Weinrich and their colleagues (Bailey et al., 1993; Bailey & Pillard, 1991; Pillard, 1996) have demonstrated the most consistent and verifiable data. Pillard found that gay men are much more likely to have gay or bisexual male siblings than heterosexual males—based on the incidence of homosexuality—but are not more likely to have lesbian sisters than are heterosexual males. Lesbians are more likely to have lesbian sisters but are not more likely to have gay brothers.

Combined with other twin and heritability studies, this research helps explain the probable genetic substrate of sexual orientation, with different genetic influences for male homosexuality, male heterosexuality, female homosexuality, female heterosexuality, and, possibly, bisexuality. Although the complex set of behaviors and feelings of homosexuality could not be explained by a single factor, a genetic basis seems to be the foundation on which other complex biological, familial, and societal influences work to shape the development and expression of sexual orientation (LeVay, 1996).

Perspectives on Bisexuality

Bisexuality has also existed throughout recorded history. Freud believed in innate bisexuality and that an individual evolves into a heterosexual or a homosexual, rarely a bisexual (Freud, 1963). Many bisexuals still find themselves contending with this lack of acknowledgment that a bisexual orientation can be an endpoint in itself and not just a step toward heterosexuality or homosexuality.

It is helpful for providers to know that the clinical issues facing bisexuals often are problems resulting from the difficulty of acknowledging and acting on a sexual orientation that is not accepted by the heterosexual majority but also not accepted by many gay men and lesbians.

Some people of color in the United States or people from different cultures may define themselves as bisexual, even if they focus exclusively on people of the same sex (Gonzalez & Espin, 1996). This perspective may be their way of coping with the stigma of homosexuality. Reviews that discuss theory and clinical issues include those by Weinberg, Williams, and Pryor (1994); Klein and Wolfe (1985); and Fox (1996).

Homophobia and Heterosexism

Wednesday, February 18th, 2009

Homophobia and Heterosexism

Having a general understanding of heterosexism, homophobia, and antigay bias is important for substance abuse treatment providers working with LGBT individuals. Alport (1952) defined prejudice as a negative attitude based on error and overgeneralization and identified the three interdependent states of acting out prejudice as verbal attacks, discrimination, and violence. Verbal attacks can range from denigratory language to pseudoscientific theories and findings, which serve as a foundation for discrimination and violence. Following this theory, prejudice and discrimination against LGBT individuals is formed, in part, by misinformation such as the following:

• All gay men are effeminate, and all lesbians are masculine.

• LGBT persons are child molesters.

• LGBT individuals are unsuitable for professional responsibilities and positions.

• LGBT persons cannot have fulfillingrelationships.

• LGBT persons are mentally ill.

Once negative generalizations are formed about a group of people, some members of the majority group feel that they can treat the other group differently. As the acceptance of negative stereotypes spreads, discrimination and violence can result.

Heterosexism and homophobia are used to describe the prejudice against LGBT people. Heterosexism is a prejudice similar to racism and sexism. It denies, ignores, denigrates, or stigmatizes any non-heterosexual form of emotional and affectional expression, sexual activity, behavior, relationship, or socially identified community. Heterosexism exists in everyone—LGBT individuals as well as heterosexuals—because almost everyone is brought up in a predominately heterosexual society that has little or no positive recognition of homosexuality or bisexuality. Heterosexism supports the mistaken belief that gay men because they are attracted to men—are in some way like women, and lesbians, in turn, are in some way like men.

Homophobia, although a popular term, lacks precise meaning. Coined in 1972 to describe fear and loathing of gay men and lesbians, it also has been used by gay men, lesbians, and bisexuals to describe self-loathing, fear, or resistance to accepting and expressing sexual orientation (Weinberg, 1983). Antigay bias is another phrase to describe the first concept, and nternalized homophobia is another phrase for the latter. Internalized homophobia is a key concept in understanding issues facing gay men, lesbians, and bisexuals in substance abuse treatment.

Examples of heterosexism in the United States include the following:

• The widespread lack of legal protection for individuals in employment and housing

• The continuing ban on lesbian and gay military personnel

• The hostility and lack of support for lesbian and gay committed relationships (except in Vermont) as seen in the passage of Federal and State laws against same-gender marriages

• The enforcement of outdated sodomy laws that are applied to LGBT individuals but not applied to heterosexual individuals.

Examples of heterosexism in the substance abuse treatment setting are as follows:

• Gay-bashing conversations

• Cynical remarks and jokes regarding gay sexual behaviors

• Jokes about openly LGBT staff members

• Lack of openly LGBT personnel

• Lack of inclusion of LGBT individuals’ family members or significant others in treatment processes.

Substance abuse treatment providers should remember that LGBT clients do not know the reaction they will receive when mentioning their sexual orientation. For example, public opinion measures indicate that homosexuality is not widely accepted. In 1996, Gallup Poll data showed 50 percent of respondents reported that homosexuality was unacceptable and only 45 percent found homosexuality an acceptable lifestyle. In addition, Herek (1989) found that as many as 92 percent of lesbians and gay men reported that they have been the target of threats, and as many as 24 percent reported physical attacks because of their sexual orientation.

It is likely that all substance abuse treatment programs have LGBT clients, but staff members may not be aware that they are treating LGBT clients. Most treatment programs do not ask about sexual orientation, and many LGBT people are afraid to speak openly about their sexual orientation or identity. Treatment programs also may not realize that they have LGBT staff members, who can be a great resource for treating LGBT clients.

Estimates of the Number of LGBT Individuals

Wednesday, February 18th, 2009

Estimates of the Number of LGBT Individuals

The true number of people who identify themselves as LGBT individuals is not known. Because of a lack of research focusing on the LGBT population and the mistrust that makes many LGBT people afraid to be open about their identity, reliable data are difficult to obtain. The popular estimate that 10 percent of the male population and 5 to 6 percent of the female population are exclusively or predominately homosexual is based on the Kinsey Institute data (Kinsey, Pomeron & Martin, 1948; Kinsey et al., 1953) addressing sexual behavior. Kinsey proposed the Kinsey Scale, a continuum that rated sexual behavior on a scale from zero to six. Zero represented exclusive heterosexual behavior and six represented exclusive homosexual behavior. The survey reported that 37 percent of American men had at least one homosexual experience after adolescence; 5 to 7 percent had bisexual experiences but preferred homosexual ones; and 4 to 5 percent had homosexual experiences exclusively.

These data illustrate how widespread male homosexual behavior is, not necessarily the number of gay men. The same research indicated that the majority of those surveyed reported behavior in a range Kinsey termed bisexual. Again, the classification is based only on reported behavior. For many minority populations, bisexuality—but not homosexuality—is acceptable (or at least admittable on surveys). For example, in the 1989 Centers for Disease Control and Prevention 8-year review of acquired immunodeficiency syndrome (AIDS) cases among gay or bisexual men, 54.2 percent of African Americans were reported to be bisexual, 44.2 percent of Hispanics were reported to be bisexual, and 11.3 percent of Caucasians were reported to be bisexual.

Michaels (1996) thoroughly analyzed the limited available data and concluded that determining prevalence rates of sexual orientations is extremely difficult because the data are widely disparate. He estimates that in the United States, 9.8 percent of men and 5 percent of women report same-gender sexual behavior since puberty; 7.7 percent of men and 7.5 percent of women report same-gender desire; and 2.8 percent of men and 1.4 percent of women report a homosexual or bisexual identity.

The data on the number of transgender people are even more limited. Some psychiatric literature estimates that 1 percent of the population may have had a transgender experience, but this estimate is based only on transgender people who might have sought mental health services (Seil, 1996).

How Heterosexism Contributes to Substance Abuse

Wednesday, February 18th, 2009

How Heterosexism Contributes to Substance Abuse

When treating LGBT clients, it is helpful for providers to understand the effect of heterosexism on their LGBT clients. The role of heterosexism in the etiology of substance abuse is unclear. Heterosexism instills shame in LGBT individuals, causing them to internalize the homophobia that is directed toward them by society (Neisen, 1990, 1993). Some LGBT individuals may use intoxicants to cope with shame and other negative feelings. Some LGBT individuals learn to devalue themselves and value only heterosexual persons instead. The negative effects of heterosexism include the following:

• Self-blame for the victimization one has suffered

• A negative self-concept as a result of negative messages about homosexuality

• Anger directed inward resulting in destructive patterns such as substance abuse

• A victim mentality or feelings of inadequacy, hopelessness, and despair that interfere with leading a fulfilling life

• Self-victimization that may hinder emotional growth and development.

Recognizing that heterosexism is a type of victimization helps the counselor and client draw a parallel with recovery from other types of victimization, whether they are culturally or individually based. It is crucial that counselors and clients recognize that these effects result from prejudice and discrimination and are not a consequence of one’s sexuality. It is not surprising to find that many LGBT individuals in therapy report feeling isolated, fearful, depressed, anxious, and angry and have difficulty trusting others. Meyer (1993) reports that the victimization of gay males in our society results in mental health consequences for individuals. A skilled substance abuse treatment counselor should be attentive to the negative effects that prejudice produces when working with LGBT clients.

Definition of Terms and Concepts Related to LGBT Issues

Wednesday, February 18th, 2009

Definition of Terms and Concepts Related to LGBT Issues

Understanding how certain terms are used is essential to understanding homosexuality. It is important to recognize the difference between sexual orientation and sexual behavior as well as the differences among sexual orientation, gender identity, and gender role.

Sexual orientation may be defined as the erotic and affectional (or loving) attraction to another person, including erotic fantasy, erotic activity or behavior, and affectional needs. Heterosexuality is the attraction to persons of the opposite sex; homosexuality, to persons of the same sex; and bisexuality, to both sexes. Sexual orientation can be seen as part of a continuum ranging from same-sex attraction only (at one end of the continuum) to opposite-sex attraction only (at the other end of the continuum).

Sexual behavior, or sexual activity, differs from sexual orientation and alone does not define someone as an LGBT individual. Any person may be capable of sexual behavior with a person of the same or opposite sex, but an individual knows his or her longings—erotic and affectional—and which sex is more likely to satisfy those needs.

It is necessary to draw a distinction between sexual orientation and sexual behavior. Not every person with a homosexual or bisexual orientation, as indicated by his or her fantasies, engages in homosexual behavior. Nor does sexual behavior alone define orientation. A personal awareness of having a sexual orientation that is not exclusively heterosexual is one

way a person identifies herself or himself as an LGBT person. Or a person may have a sexual identity that differs from his or her biological sex—that is, a person may have been born a male but identifies and feels more comfortable as a female. Sexual orientation and gender identity are two independent variables in an individual’s definition of himself or herself.

Sexual identity is the personal and unique way that a person perceives his or her own sexual desires and sexual expressions. Biological sex is the biological distinction between men and women.

Gender is the concept of maleness and masculinity or femaleness and femininity. One’s gender identity is the sense of one’s self as male or female and does not refer to one’s sexual orientation or gender role. Gender role refers to the behaviors and desires to act in certain ways that are viewed as masculine or feminine by a particular culture.

A culture usually labels behaviors as masculine or feminine, but these behaviors are not necessarily a direct component of gender or gender identity. It is common in our culture to call the behaviors, styles, or interests shown by males that are usually associated with women “effeminate” and to call the boys who behave this way “sissies.” Women or girls who have interests usually associated with men are labeled “masculine” or “butch,” and the girls are often called “tomboys.”

Transgender individuals are those who conform to the gender role expectations of the opposite sex or those who may clearly identify their gender as the opposite of their biological sex. In common usage, transgender usually refers to people in the transsexual group that may include people who are contemplating or preparing for sexual reassignment surgery— called preoperative—or who have undergone sexual reassignment surgery—called postoperative. A transgender person may be sexually attracted to males, females, or both.

Transvestites cross dress, that is, wear clothes usually worn by people of the opposite biological sex. They do not, however, identify themselves as having a gender identity different from their biological sex or gender role. The motivations for cross dressing vary, but most transvestites enjoy cross dressing and may experience sexual excitement from it. The vast majority of transvestites are heterosexual, and they usually are not included in general discussions about LGBT people.

Gender identity disorder (GID) was introduced in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM–IV) (American Psychiatric Association, 1994). Although GID is listed as a mental illness, most clinicians do not consider individuals who are confused or conflicted about their biological gender and their personal sense of their gender identity to be mentally ill. Considerable work needs to be done to augment the small amount of research available on the development of a transgender identity—that is, how a person becomes aware of a sexual identity that does not match his or her biological sex or gender role.


Tuesday, February 17th, 2009


The Center for Substance Abuse Treatment (CSAT), part of the Substance Abuse and Mental Health Services Administration, funded three clinical sites and a Coordinating Center (CC) to design and implement the Marijuana Treatment Project (MTP) in the late 1990s. A major focus of CSAT is rigorous testing of approaches to treat marijuana dependence in both adults and adolescents. MTP studied the efficacy of treatments for adults who are dependent on marijuana. At the time of funding, MTP was one of the largest Knowledge Development and Applications initiatives funded by CSAT. Another was the Cannabis Youth Treatment (CYT) Study, which resulted in the CYT Series, a five-volume resource that provides unique perspectives on treating adolescents for marijuana use (Godley et al. 2001; Hamilton et al. 2001; Liddle 2002; Sampl and Kadden 2001; Webb et al. 2002).

This manual for Brief Marijuana Dependence Counseling (BMDC) is based on the research protocol used by counselors in MTP. The manual provides guidelines for counselors, social workers, and psychologists in both public and private settings who treat adults dependent on marijuana. The 10 weekly one-on-one sessions in the BMDC manual offer examples of how a counselor can help a client understand certain topics, keep his or her determination to change, learn new skills, and access needed community supports (exhibit I-1). Stephens and colleagues (2002) describe the MTP rationale, design, and participant characteristics.

Me? Hooked on Pot?

Many individuals for whom this intervention was designed often have difficulty accepting that they are dependent on marijuana. The topic is controversial, even for those who walk through a counselor’s door to talk about their marijuana use. People who become clients in BMDC may have

• Put off actions and decisions to the point of being a burden on family and friends

• Given up personal aspirations

• Had nagging health concerns, such as worries about lung damage

• Made excuses for unfinished tasks or broken promises

• Experienced disapproval from family and friends

• Been involved in the criminal justice system.

Case Examples


A Caucasian father of two teenagers, Doug was in his early 40s when his wife forced him to talk

to a counselor about marijuana. He was not happy to be in the counselor’s office. “What’s the big deal?” he asked. “It’s just pot.” Doug’s wife had given him an ultimatum: either he quit getting high or she would move out. She delivered this ultimatum when their 15-year-old son was suspended from school for smoking marijuana.

When they were younger, Doug and his wife smoked pot together. As their children grew older, however, his wife gave it up. For a long time, she tolerated Doug’s continued use, with their agreeing that he’d be discreet. Both felt that the children should not know about his using. Doug tried to be careful, but a few times his son had walked in on him using marijuana.

“Why can’t you settle for my promising to try harder to hide it from the kids?” he argued. “It’s not

as if it’s really a problem. After all, our family benefits from my income.”

Given what he said in the first several minutes he spent with the counselor, he saw the real issue as his wife’s refusal to be reasonable. But Doug also mentioned that he wondered, “What will people think if word gets out that I smoke marijuana?”


Shirley struggled with thoughts about marijuana and its effects. An African-American mother of

three girls, Shirley was troubled by what she perceived as a conflict between her personal and

professional lives.

Getting high helped her relax and sleep. Shirley had first smoked pot with a favorite uncle, and

other members of her close-knit family had experienced getting high. No one was critical of her

smoking. However, Shirley wanted to be an elementary school teacher. While student teaching,

she was struck by the incongruity of having chosen a profession that called for being a good role model for children yet regularly getting stoned. She had thought a lot about quitting. When she tried to stop, she felt agitated and had difficulty sleeping. Shirley worried that she might not

succeed in changing. She started seeing a counselor to sort out her confusion.

Like Doug, Shirley was grappling with a complicated issue. Doug and Shirley perceived aspects of their marijuana experiences as positive, yet they were troubled by possible consequences.


A 36-year-old married Hispanic man, Miguel has known for years that getting high is no longer a

casual part of his life. When he tried to stop, he got angry at the slightest provocation, could not

relax, and inevitably returned quickly to frequent use.

Not too long ago, Miguel made an appointment at a drug treatment agency but never showed up. The agency employee who answered the phone asked him, “Is marijuana the only drug you use?” He thinks that he needs help but doubts that anyone would understand how he feels. He does not want to be treated like an addict.

Causes, Problems and Treatment Options for Sleep Apnea Disorder

Tuesday, October 28th, 2008

Sleep apnoea is a most dangerous disorder where an individual stops breathing while sleeping. Such kind of  people awaken often during the night to take a breath of air. This can happen 200 times in a night. Snoring is the also the chief indication that a person has apnoea.

Sleep apnoea is mostly found in overweight, middle-aged men. It may be more severe if experienced at a younger age. However, women can also suffer from apnoea and it is also experienced by children.

Obstructive apnoea

If a person has obstructive apnoea, the person cannot get air in. The airway from the nose to the windpipe narrows or closes. People with obstructive apnoea are less likely to remember waking than are those with central apnoea.

Central apnoea

If a person has central apnoea, the brain has failed to send messages that breathing is needed. The diaphragm and intercostal muscles stop working, so the person stops breathing. They wake to take a breath. People may remember such incidents. This condition is less common than obstructive apnoea.


A person with sleep apnoea may not realise they have the condition — unaware of their frequent awakenings and snoring. Indicators to look out for are complaints about snoring, waking during the night and feeling tired the next day for no apparent reason.

Possible causes

One major cause of obstructive sleep apnoea is obesity.
Research is suggesting that asthma in women increases their risk of developing obstructive sleep apnoea.

Potential problems

The person rarely gets a good night’s sleep due to the frequency of awakening which means they tend to not enter the deeper stages of sleep. There are a number of consequences of sleep deprivation that can affect daily functioning if it goes on for some time.

Sleep apnoea can cause heart problems. Many people with sleep apnoea suffer from hypertension. A person can have a heart attack or stroke, both which can be fatal.

Recent research is suggesting an association between sleep apnoea in children and brain injury. Such injury affected the child’s memory, attention and learning.


There is no simple cure, although there are a number of steps a person can take to try to alleviate the number of episodes experienced.

Try losing weight; Try sleeping on the side, rather than the bac; Cutting down on alcohol consumption and giving up smoking can help; A person with sleep apnoea should avoid using sleeping pills since they make waking up more difficult, preventing the person from taking a much needed breath; Recent research has found didgeridoo playing reduced episodes by strengthening the airway and other treatments include surgery, special nasal masks and dental appliances.

If you suspect you have the symptoms of apnoea, consult your medical professional immediately so that you can be referred to a sleep clinic.

What Is Congenital Hypothyroidism?

Tuesday, October 2nd, 2007

If the level of thyroid hormones reduces to where they no longer can carry out their intended function, Congenital hypothyroidism happens. These conditions are fairly rare, but statistics show that for every male victim, there are two females who suffer this disorder. This disease is usually hereditary, so if you have this condition, there is a high risk that your child may suffer from it as well. This doesn’t mean that your child is safe if you do not have the condition.

Exposure to radioiodine or intake of anti-thyroid drugs for medicinal purposes may cause congenital hypothyroidism in your children. It is not contagious, though, and some cases are temporary. Early diagnosis is important so that the disease does not cause permanent damage.
Even if your child has been screened as a newborn, it is important that you recognize the symptoms at a very early stage. Causes for concern include poor eating; constipation; a child who cries very little, yet always sleeps; a large tongue, head or belly; umbilical hernia; spots on the head that are large and close slowly; respiratory distress; fever; below normal heart rate and blood count; slow physical development; floppy muscles; slow teething; late milestones in life; wide but short hands; and slow mental development.

Blood tests are the only way to accurately determine if your child has this condition. If he is not treated and given immediate attention, he may never learn to speak and the symptoms could become permanent. Usually, once congenital hypothyroidism is confirmed, it is no longer reversible. Mental illenss and other issues caused by the disease can be prevented by thyroid hormone supplements.