Tag: Mental Health

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Dissociative Identity Disorder and Trauma: Coping and Healing

Have you ever driven home lost in thought, unaware of what you experienced during your drive? Not even sure if all the lights you passed were green? People often chalk that up as dissociation, which is true. It can feel a little freaky or odd, but it’s been normalized as something that happens to everyone. Someone living with dissociative identity disorder (DID) experiences a much different reality—severe dissociation, gaps in their memory, and new identities that develop.

Trauma can cause DID. Many experts have explored this connection, including Athena Phillips, who we spoke to in our recent podcast episode. You can listen to that here. 

What Is Dissociative Identity Disorder (DID)?

Dissociative identity disorder, once known as multiple personality disorder, describes someone with two or more separate, independent identities1 or ‘alters.’ People can have dozens of alters with their own habits, memories, and even genders. DID is one of several dissociative disorders1 marked by derealization, memory loss, distorted self-identity, and disruptions in consciousness. 

Each identity has their own view of the world and makes their own decisions2. Someone with DID may know about all their alters or just a few, especially ones that come out more often. Patients typically experience memory loss when various identities take over—alters aren’t usually aware of what the others are doing, and memory loss occurs as a result. For example, if an alter brings home a new vase, someone with DID may not recognize it later or know where it came from.

Each alter has their own first-person experience and forms memories based on what they see, feel, and think. Other alters and the true self aren’t usually able to retrieve these memories2, though many clinicians propose they could if they didn’t strongly believe they can’t. Believing they can access an alter’s memories could allow the true self or other alters to retrieve them.

Causes of DID

DID most often occurs as a response to trauma1, typically physical, sexual, or emotional abuse in childhood. The post-traumatic model of DID2 proposes that “​​dissociative identities are the primary results of early trauma and the relational, cognitive, emotional, and neurobiological consequences of it.” Children may unconsciously resort to dissociation and numerous personalities to both avoid and cope with traumatic memories.

Each alter develops as a disconnected, separate, autonomous subset of the self. Picture islands separated by deep waters instead of one town. The true self may travel to different islands depending on what their situation demands and memories that arise, often memories of severe trauma. Once the true self goes to an island, it becomes their whole reality and remains closed off from the other islands.

Clinicians and researchers have found trauma to be the leading and primarily identifiable cause of DID2, though some genetic dispositions, social influences, and personality traits could contribute to dissociation and someone’s inability to cope with stress. Someone who’s more likely to experience dissociation and struggle to deal with stress could be more likely to develop DID.

Diagnosing DID

Most people with DID don’t get an accurate diagnosis until later in life1 because DID has similar symptoms to other personality disorders, including amnesia, dissociation, and losing consciousness. Particularly, borderline personality disorder (BDP) shares similar symptoms, and like DID, patients often present as suicidal and engaging in self-harm. BPD patients also struggle with emotional regulation and dissociation. To meet diagnostic criteria for DID, experts say patients must present with these 4 factors1:

  1. The ability to dissociate
  2. Intense, overwhelming traumatic experiences 
  3. Alters with unique personalities, names, and memories
  4. Homelife instability

Children may cope with unstable homes and overwhelming trauma by self-soothing through dissociation and developing alters. Someone with DID also has altered brain structures3, usually the hippocampus and amygdala, which can affect memory and overall functioning. Looking at the brain can help doctors accurately diagnose DID and rule out other diagnoses. Observing patients also clues doctors into the personality shifts related to DID, as a few key physical signs often occur:

  • Eyes rolling
  • Fading into a trance-like state
  • Blinking or twitching eyes
  • Sudden posture changes

History of DID

Until 1994, DID was known as multiple personality disorder and not well understood3 or sympathized by the medical community. Its strong connection to trauma has recently become better known and understood, helping patients get the diagnosis and help they need.

Before it was recognized as a mental health condition, DID was thought to be the work of demonic possession1. Cultures outside North America were more likely to attribute symptoms to possession, while schizophrenia or psychosis incorrectly explained many symptoms in other cultures. Internal voices from other alters were explained as schizophrenia, which can have similarities.

How Trauma Can Lead to Dissociative Identity Disorder

Children or adults who experience more trauma and stress than they’re capable of dealing with can develop DID as a coping mechanism1. Their experience goes beyond what their mind can process and articulate, leading to dissociation as a way to escape and alternate identities to process a fractured sense of self. 

Certain alters may be more capable of dealing with the traumas experienced and come out when situations mimic the original trauma, or memories of the trauma arise. For example, a tough male alter may take over when a female with a history of assault feels uncomfortable around certain men. He comes out to protect her and deal with a situation she cannot. 

Dissociation as a Predictor of DID

Intense trauma can cause dissociation1, as seen in some cases of post-traumatic stress disorder. An out-of-body experience during an assault can be the brain’s effort at protection. Children who suffer repeated abuse or instability in their homes may regularly dissociate to protect themselves. Alters can eventually present during dissociation and take over general consciousness, leading to amnesia. 

Small Social Cues Can Trigger Shifts in Identity

Social cues can prompt small behavioral changes, triggering an alter to take over2 in someone with DID. As an example, picture a formal event. This requires professionalism and different social etiquette. Someone without DID could adapt to the situation by speaking more formally, standing straighter, and carrying themselves differently. But someone with DID may unknowingly shift to an alter identity that’s more poised and professional. Their true self may not remember the event or what they talked about if the alter takes over.

Treatment for DID and Trauma

Effective treatment addresses the symptoms of DID and its underlying trauma1. Clinicians often use cognitive behavioral therapy (CBT), dialectical behavioral therapy (DBT), and eye movement desensitization and reprocessing (EMDR) to treat DID, similar to other personality disorders. For DID patients specifically, hypnosis has been an effective option to reach alters and discuss their memories, views on the world, and life experiences. 

Therapy teaches patients with DID more about their condition, how to regulate their emotions, manage stress, and function in day-to-day life with their unique symptoms. Therapists work with the patient to glean memories from different alters and piece together underlying trauma so the true self and their alters can begin processing. As therapy brings more memories to light, they can become more readily accessed by different alters and the true self. 

Finally, therapy works to reunite the self1 and help patients with DID become more aware of their unified self and its relationship to the world they interact with. Reunifying their sense of self can reduce the number of alters, though therapeutic interventions often can’t merge them all. But with fewer alters, patients are more likely to remain as their true selves throughout various situations and potential triggers. 

EMDR and Hypnosis

Patients with DID respond well to hypnotherapy1 as they’re more receptive to hypnosis. In their hypnotized state, therapists may be able to talk to alters that traditionally stay hidden. These alters can be crucial to the healing process and help the therapist learn more about their patient, giving access to memories and experiences the true self and other alters may not know about.

EMDR uses guided eye movements to help patients process trauma4. Tracking an object back and forth offers a distraction and can make traumatic memories feel less intense, helping patients discuss and process them without shifting to an alter identity or becoming too uncomfortable. Not every patient with DID will feel comfortable accessing memories through EMDR, but for those who are, it can help unify their sense of self and manage symptoms.

Medications

Some medications, like antipsychotics and antidepressants, can manage symptoms of DID like suicidality, mood dysregulation, and improve self-harm behaviors. However, clinicians haven’t yet found a medication or combination of medications to treat DID1. More options may become available as they study and develop new medications. 

Optimized Care for DID Patients

A safe therapeutic environment and collaborative, compassionate care can help DID patients1 find the best treatment outcomes and stay in treatment. Therapists should also recognize and stay aware of alters not communicating what patients learn or discover in sessions. They’ll likely need to bring each alter forward to ensure they talk with them and identify their unique personalities. Building rapport and comfort also encourages alters to come out and speak with their therapist.

Life-Long Care

Patients with DID often stay in treatment their whole lives1 to receive ongoing grounding in their unified self, process trauma, and navigate stressors as they arise. In some cases, it can take years for the therapist to meet and identify each alter. A positive relationship between the patient and their therapist (and treatment team as a whole) is crucial in keeping them in treatment and creating a comfortable environment.

Identifying Alters

Therapists can aim to identify all alters, helping patients become more aware of them, their personalities, and what triggers them to arise. Once patients and their therapist know who’s all there, they can work on identifying their backgrounds and merging alters into one self identity. Therapists can bring alters ‘to the front’ using hypnosis or, if appropriate, mimicking a situation that would bring out a suspected alter. 

Compassionate, Personalized Care

Ultimately, therapists should adapt treatment to their patient by recognizing their comfort levels, assessing their trauma responses, and building a positive therapeutic relationship. Identifying alters and processing trauma shouldn’t come at the patient’s harm. The therapeutic relationship can determine which treatments may be most effective and comfortable for each patient, encouraging them to engage and participate throughout the course of treatment.

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Debunking the Rock Bottom Myth: A New Perspective on Addiction Recovery

The “rock bottom” myth suggests someone must hit a catastrophic low point before they recover from addiction. While pain and negative consequences can motivate change, it can be misguided and even dangerous to require this of everyone with an addiction. Many recover or start treatment without hitting their rock bottom. Staying connected to loved ones, work, and daily life often supports recovery.

Rock bottom is considered the ultimate low in someone’s life, like losing loved ones, money, status, freedom, and possessions. It can be a singular event of cumulation of consequences. Everyone will have a different rock bottom, which makes the myth even less defined—one person may consider becoming homeless and unemployed rock bottom, another may consider getting divorced to be their rock bottom.

Viewing “rock bottom” as the only entry point into treatment can harm a person with addiction and their loved ones. Instead of waiting to reach rock bottom, they can take agency over their treatment journey and seek help whenever they feel it’s necessary.

What Is The Rock Bottom Myth?

The rock bottom myth views hitting “rock bottom” as a requirement1 for addiction recovery. It sees pain, grief, and negative consequences as motivators for going to and engaging in treatment. While this can be true and often is, not everyone needs to hit a breaking point to get treatment or want help. You certainly don’t need to reach rock bottom to deserve help. 

The rock bottom myth originated in the 12-Steps2 of Alcoholics Anonymous (AA), where hitting rock bottom was once a sign participants were ready to practice and commit to the 12 Steps (and recovery). Rock bottom was portrayed as a launching pad into recovery. If participants didn’t reach this point, they weren’t seen as being able to commit to recovery and/or recover fully.

More recently, the rock bottom myth has faded to make room for unique recovery journeys, motivations, and underlying causes of addiction.

The Dangers of the Rock Bottom Myth

Waiting to hit rock bottom and going through it as a prerequisite for recovery poses several dangers. The components of rock bottom can be dangerous in themselves, like homelessness or committing a crime. 

The rock bottom myth can also keep someone from getting treatment and continuing in their addiction, which harms their mind and body. Waiting for a flip to switch, an epiphany, or acute realization of being at rock bottom delays treatment and can contribute to denial.

Someone may hesitate to pursue treatment if they’ve not hit a clear breaking point. They may worry treatment professionals won’t take them or their needs seriously if they don’t have evidence of hitting rock bottom. This can delay treatment, cause shame, and deepen hopelessness. These feelings can even build into a crisis point.

Rethinking Recovery: Early Intervention and Support

Early intervention is found to be the most effective preventative measure2 against addiction and its consequences. It can prevent addiction from worsening to a breaking point, and the harms that come with that. Knowing you can get treatment at any point, not just at the end of your rope, can encourage people to seek treatment sooner. 

Recognizing signs of addiction can help you get treatment early. For example, you may notice you’re drinking every night and feel uncomfortable or ill when you try to stop. Even though it hasn’t affected your relationships, work, or finances, you still feel like something’s wrong. Getting treatment once you realize that can stop its progression and hitting rock bottom.  

Alternatives to the Rock Bottom Approach

Many avenues to recovery don’t rely on hitting rock bottom or anything close to it. You can find the motivation to heal and treat underlying symptoms through therapy, supportive relationships, and various community resources.

Therapies like cognitive behavioral therapy (CBT) and motivational interviewing can disrupt unhealthy thought patterns and teach healthy coping mechanisms. Exploring past events and trauma can also help you identify triggers, connect them to substance or behavioral addictions, and find new ways to cope.

Connecting to peer support and community resources prevents the isolation and loneliness that can feed into substance use. Stay close to friends and loved ones, and try joining an in-person or online group focused on recovery. Twelve-Step groups may be a good option for you, or you could attend non-12-Step groups like SMART recovery. You could also join non-recovery focused communities, like clubs or sport teams, to meet new people and grow your support network. 

These communities and support networks can jumpstart your recovery by offering a subjective view of your situation. For example, an honest conversation with a friend or family member may open your eyes to your need for treatment, before you start experiencing consequences. Listening to their concerns and ideas can inspire you to begin treatment with their support. 

Shifting Societal Perceptions on Addiction and Recovery

Addiction and mental health conditions aren’t fully understood by the public—unless it happens to them or someone they love. This misunderstanding can lead to prejudice and stigma, which can make it hard for anyone to admit to struggling with a mental health condition or addiction. This can hinder early intervention and land people at their rock bottom.

Awareness on addiction, mental health, and the realities of recovery can change how the public views these conditions. Rather than seeing it as something that must reach a certain drastic point for treatment, addiction can instead be seen as something you treat as soon as you notice symptoms, much like most illnesses or wounds. If addiction or mental health conditions were seen in this light, more and more people might feel willing to admit their struggles and seek treatment before it becomes consuming.

Thankfully, many efforts and organizations are actively working on making the public aware of the realities of addiction and mental health—and reducing stigma along the way.

  • To Write Love On Her Arms raises awareness for depression, suicide, self-injury, and addiction. They offer a message of hope and unity and donate to treatment efforts by selling merchandise. 
  • The Herren Project helps individuals and families find treatment with personalized support and scholarships to cover treatment costs. They’re founded by former NBA player Chris Herren, who recovered from addiction and seeks to reduce the stigma surrounding recovery, bring awareness, and provide hope.
  • Red Ribbon focuses on youth and drug use prevention in schools. They advocate for drug use prevention and recovery, hosting events to spread awareness and help more and more people commit to drug-free lives.
  • The Pan American Health Organization (PAHO) runs a mental health awareness campaign addressing stigma and discrimination. They encourage countries and people to #DoYourShare in reducing stigma and making treatment more accessible.
  • CALM’s “Suicidal doesn’t always look suicidal” campaign uses photos and videos of people before the took their own life to bring awareness to suicide, encourage treatment, and start much-needed conversations without shame or judgment.
  • State campaigns are often run by state governments and aim to bring awareness to addiction and help people connect to treatment. Search the internet for local campaigns or check community centers, libraries, and churches in your town or city.

How to Seek Help Without Hitting Rock Bottom

You don’t have to hit rock bottom to heal. If you’re experiencing symptoms of addiction or a mental illness and notice they have an effect on your life, ask yourself, “Do I want to keep living like this?” The answer can inform what you do next.

If you answer no, you can begin seeking treatment or implementing changes into your daily life. You can set up an appointment with your primary care physician, bring your concerns to them, and see what they recommend. Keep questions like these in mind to get a full understanding of your condition and treatment options:

  1. Do my symptoms and experiences fall under a diagnosis? If so, which one(s)? (This can help insurance cover the costs of treatment.)
  2. What lifestyle changes or new habits would you recommend to improve my symptoms?
  3. Do you recommend I start medication to manage my symptoms? If so, which one, and what are its side effects?
  4. What type of treatment or level of care would you recommend?
  5. Will I need a referral for my next steps in treatment?

Use Recovery.com to find treatment centers for your condition and preferences, filtering by insurance coverage, amenities, and location. 

Helping Someone Else

An open and non-judgemental conversation with a friend or loved one could save them from the life-altering effects of hitting rock bottom—and even save their life. 

You may notice a friend or family member acting differently; seeming ‘off.’ They may drink more often or get drunk more regularly. They may seem sad and view life through a suddenly cloudy lens. If you notice signs like these or just intuitively know something’s wrong, voice your concerns calmly, non-judgmentally. Here’s how that could look:

  • “I’ve noticed you seem down lately. Would you like to talk to me or someone else about it?” 
  • “I see you’ve been drinking more and more often. Do you think you might need help to stop?”
  • “I feel like you’ve been acting differently lately—you seem sad. Can I help you, or help you find help?”

Together, you can look into treatment options, just talk, or both. Your support and care can make all the difference. 

Bridging Rock Bottom With Early Intervention

You don’t have to hit your breaking point to heal. Though the rock bottom myth holds truths about motivation to change, it’s not necessary for successful recovery. Getting help as soon as you notice signs in yourself or someone else can be key to early intervention and healthy living.
Browse Recovery.com to find a treatment center that fits your needs.

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Rural Recovery: Challenges and Hope

Rural areas offer great benefits, like a slower pace of life, open fields, and close-knit communities. But what happens when they can’t provide the resources someone vitally needs, like addiction and mental health treatment? Lacking what many urban dwellers take for granted—access to resources—can endanger the billions of people living in rural communities worldwide. 

Thankfully, technology has opened new doors for rural areas. With just a phone or laptop and internet access, people can attend therapy online and even virtual rehab. Increased mental health awareness in small communities may also create new and improved resources for areas in desperate need.

To learn more about the healthcare challenges in rural areas and how providers navigate them, listen to our recent podcast episode featuring Dr. Jonathan Rosenthal!

Behavioral Health Challenges in Rural Areas

About 1/5th of rural Americans have a diagnosed mental health condition1. Urbanites make up close to the same. However, those in rural areas have more trouble accessing care and finding clinicians, as opposed to urban cities with multiple clinics and practices to choose from. 

Over 60% of rural Americans live in ‘mental health provider shortage’ areas1, with 65% of rural counties without psychiatrists. Waiting lists for therapy or more intensive care can extend for months. Limited mental health knowledge and stigma often prevent rural residents from seeking treatment at all. If they do, low availability often means they must choose the first provider they can get, whether they’re a knowledgeable fit or not. Personalized care can become more of a luxury than a necessity.

Primary care physicians (PCPs) often become the first and only line of defense for mental health conditions and substance use. While PCPs can prescribe medications and recommend next steps, they often don’t have the specialized training in mental health or addiction to educate and support patients properly.

A Top Challenge: Growing Suicide Rates in Rural Communities

Rural residents are twice as likely to die by suicide than urban residents1. Isolation, stigma, poverty, and an inability to access care contribute to the steadily growing rate of rural suicides. Timely access to care, crisis services, and increased awareness of mental health could lower the risk of suicide among rural residents, particularly veterans and young adults. 

Boundaries to Effective Care in Rural Communities

People in rural areas face several prevalent barriers to care, including limited availability of resources, long travel times to get to treatment, and stigma. 

Lack of Access

Here’s a story highlighting a common treatment scenario in rural communities, where the necessary treatment simply isn’t available:

  • Rosie has been struggling with severe depression and loneliness. After months of waiting, she finally got into therapy. Rosie thinks group therapy would help her feel less alone and stigmatized. Her therapist agrees, but tells Rosie they don’t have any groups in town. Rosie keeps going to individual therapy but misses out on an aspect of treatment she feels is crucial.

Not having access to is the biggest bar to effective care1. Often, those in rural communities simply don’t have clear or easy access to treatment (or any access at all) and thus don’t receive it. And when they do seek treatment, overwhelmed medical providers can only refer to whatever resources they have and hope availability opens up.

Rosie’s story is a poignant illustration of the challenges faced by those seeking mental health care in rural areas. After enduring a prolonged wait to receive therapy, she encounters another hurdle: the absence of group therapy options in her area, which she and her therapist agree could be vital for her recovery. This scenario highlights the disparity in mental health resources available in less populated regions and the significant impact it can have on those in need of comprehensive care.

Long Wait Times

Waiting time poses another barrier to care. Here’s a second scenario highlighting this:

  • Darren has a paralyzing fear of socializing and talking in groups. He feels something isn’t right and seeks out therapy, but hears he’ll have to wait at least five months to get in. To manage his symptoms in the meantime, Darren starts bringing alcohol with him to work and getting tipsy to deal with his social anxiety. 

With these long wait times, symptoms can worsen; patients could lose motivation and back out. Being unable to access care could lead to substance use as a way to cope with conditions like depression, trauma, or anxiety. 

Darren’s situation underscores the pressing challenges that arise from the lack of timely access to mental health services. Suffering from a paralyzing fear of socializing and speaking in groups, Darren recognizes the need for professional help and reaches out for therapy. However, he bumps into a discouraging five-month wait. In a desperate attempt to manage his escalating anxiety, Darren resorts to bringing alcohol to work, using it to lessen his discomfort in social situations. This scenario highlights the detrimental effects that can occur when immediate mental health support is unavailable.

Behavioral Health Illiteracy

People in rural communities may not know how to identify behavioral health issues1 or how to get treatment. Bigger cities and communities often have more programs and initiatives highlighting behavioral health treatment and broadening awareness.

Stigma

Without adequate knowledge of behavioral health conditions, stigma can make mental health challenges and addiction seem unimportant or weak, discouraging rural residents from seeking help. Living where everybody knows everybody, they may worry they’ll be judged if they try to get help or admit to a problem. 

Travel Times

Rural residents often have long drives to get to a treatment facility or clinic that meets their needs. Juggling the time spent on the road, work, and other personal obligations can delay care2 or keep them from seeking it altogether. Here’s a predicament a farmer may face when trying to get treatment:

  • Bill seeks out treatment for his alcohol use disorder and needs a psychiatrist to go to once a week. The closest psychiatrist to him practices an hour and a half away, which means he’ll be gone for almost four hours each time. But Bill runs his own cattle farm, and he needs to milk his cows every morning and ensure they’re fed. Leaving for 4 hours feels out of the question; he cancels his appointments and decides to deal with his symptoms alone. 

Solutions for Better Access and Support

Rural areas need more general physicians, therapists, and specialists to meet the rising demand for behavioral health services. Incentive programs in some states encourage new physicians to practice in rural areas1, which could steadily grow their workforce and improve access to care. Other solutions, many already in play, include:

Virtual Care

Virtual care uses the internet3 to connect patients and care providers virtually. Since COVID-19, virtual care has become more commonplace and can serve as a vital connection for rural residents and treatment providers. You only need a phone or laptop and an internet connection to access virtual care. You’ll use a secure online platform to conveniently meet with a doctor, therapist, psychiatrist, or other healthcare provider.

With virtual care, you don’t have to live in a certain city or near a therapist’s office. You can even attend residential rehab online and outpatient levels of care. And with a larger pool of providers and specialists to choose from, you can get into treatment faster and find care specialized to your needs. 

Incentives for Rural Providers

Some state governments have incentivized more healthcare providers1 to practice in rural communities. If they practice for a set number of years, they receive additional financial compensation. If every state had the funding for this initiative, it could repopulate the rural workforce with eager health and mental health providers.

Increased Behavioral Health Training

Additional training would benefit current rural providers1 and help them make better-informed decisions on patient care. Primary care physicians would understand all the available options, including virtual care and local crisis services for mental health and addiction. Some programs have started training non-professionals to provide peer support, which has had success in the rural Native Alaskan community.

Known and Accessible Suicide Prevention Strategies

Death by suicide occurs more commonly in rural populations1, especially in kids, young adults, and older adults. Social isolation and not knowing what support they have can lead to untreated crises. Many programs and crisis services do exist and specifically serve rural populations, like local crisis teams, but residents don’t often know they’re there.

Educating community members on their available crisis services and support programs could save lives. Community leaders could make their crisis services more prominent and accessible by posting them in daily newspapers and highlighting crisis hotlines like 988 (National Suicide Prevention Hotline). Schools, churches, and businesses could also spread the word to destigmatize mental health and inform residents of their resources.

Better Support for Physicians

Physicians and mental health professionals face burnout in all settings, but rural providers can end up shouldering high caseloads and pressure to treat more people than they reasonably can. Compassion fatigue and discouragement can drive providers to areas with better support, so providing support in rural settings could help them stay. Financial incentives could bring more practitioners to rural areas, also lightening the load for current practitioners. 

Psychological care, peer support, and financial benefits can help providers retain their well-being and compassion, essentially helping them help others.  

Future Goals and Ideas

In an ideal world, rural populations would have the same access to and knowledge of mental health and addiction care as urbanites. Virtual health would fill in the gaps, with more better-trained and better-supported providers meeting the high need and demand for behavioral healthcare. Awareness and education on behavioral health would reduce stigma and help people feel more comfortable asking for help. 

Low-Cost Clinics

Low-cost clinics, funded by grants or donations, could offer the affordable care many rural residents in poverty need. Staff at these clinics could educate patients on good mental and physical health, with free resources for improving their diet and creating healthier habits.

Funding Local Resources

Funding for local programs could strengthen community services, too, helping them offer more robust non-clinical services. For example, funds to a local crisis support unit could go towards hiring full-time staff with specific crisis training.

In rural areas and beyond, everyone who needs treatment should have a clear path to it and support along the way, whether from their doctor, family, other community members, or all three. 

Learn more about future goals and ideas in improving rural healthcare by listening to our recent podcast episode here!

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Beyond Paradise: Exploring The Realities of Rural Healthcare in Hawaii

We were thrilled to talk with Dr. Jonathan Rosenthal, a hospitalist from Kauai, Hawaii, about his 23+ years as a hospitalist and his unique experiences practicing in rural Hawaii. In our newest episode, Dr. Jonathan Rosenthal talks with hosts Dr. Malasri Chaudrey-Malgeri, Editor-in-Chief, and Cliff McDonald, Chief Growth Officer.

Listen to Dr. Rosenthal’s episode and hear from our previous guests here!

Finding a Fit as a Hospitalist

Dr. Rosenthal is a hospitalist in an intensive care unit (ICU). He sees people in the emergency room and admits them into hospital care, working with his patients daily until they’re ready to leave treatment. Dr. Rosenthal has been working as a hospitalist in the remote town of Kauai for almost 13 years, starting his career in urban Seattle.

Dr. Rosenthal came to Kauai seeking a better quality of life and settled in, now living on the island with his wife. Kauai’s rural setting means Dr. Rosenthal works at the only major hospital on the island. He and his other 5-7 coworkers balance the needs of the island’s hospitalized patients. 

Challenges Faced in Rural Populations

Dr. Rosenthal’s community faces distinct challenges, like not having access to care, poverty, health illiteracy, and unhealthy eating. He frequently encounters metabolic disorders like diabetes, obesity, and hypertension as residents don’t have the means or access to healthy foods. Meth use also runs rampant:

“​​I was blown away that, like how frequently, you would come across people who are using methamphetamine. It’s really rampant. It often leads to problems that I need to see them for.”

Dr. Rosenthal notes his community has no public resources for the issue of meth use, making awareness and treatment difficult. Finding affordable care also poses a challenge for impoverished residents. 

For the physicians, they face discouragement from a lack of resources and support. Compassion fatigue, burnout, and the grief of being unable to help everyone pose significant challenges for providers in Kauai and other rural areas.

Encountering Wide-Spread Addiction and Mental Health Concerns

Of patients Dr. Rosenthal sees from the ER, he estimates:

“Almost every single time if you have to be hospitalized and you’re under 40, maybe 90 percent of the time, you have some sort of substance abuse and/or mental health, usually both, problem accompanying whatever else is going on.”

As the first line of defense, the emergency room takes the primary load of cases involving addiction and severe mental health concerns. Dr. Rosenthal highlights the inadequacy of emergency treatment for long-term recovery, as patients receive treatment for symptoms but not underlying issues.

Ideas and Solutions for All Rural Communities

Dr. Rosenthal notes Kauai actually has one of the highest life expectancies in America, but a large subset of the population are “still quite unhealthy” and don’t have access to healthy foods, as most of Kauai’s wealthier residents do. Nutrition education could go a long way in re-shaping eating habits and lowering the high rate of metabolic disorders.  

As for the addiction concerns his community faces, Dr. Rosenthal says, 

“We need to come up with some sort of public health system that will incentivize people to get clean and stay clean. And to be healthy in general.”

Dr. Rosenthal dreams of opening a low-cost clinic for impoverished residents to get affordable care and pick up fresh fruits and vegetables. Healthy food in his hospital’s cafeteria would also improve access to healthy foods. Showing residents what healthy foods they could buy with constrained budgets and providing cooking classes would educate residents and encourage healthier eating. 

Virtual addiction and mental health services can also make care more accessible for rural patients, as they’d only need a device and internet access to get treatment. Services like these could lighten the burden for Kauai’s emergency rooms and providers like Dr. Rosenthal. Making these resources known through community outreach plays a vital role in patient education and people using their resources.

Listen to Dr. Rosenthal’s episode on The Recovery.com Podcast to hear about his inspiring work and ideas. 

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The Untold Power of Compassionate Care: Addressing Stigma with Dr. Ishant Rana

In our recent podcast episode, Recovery.com was thrilled to talk with Dr. Ishant Rana, Clinical Director at Alpha Healing Center. We explored the weight of stigma in India and how rehabs like Alpha Healing Center actively shift from punitive approaches to compassionate, personalized care. Dr. Ishant describes the impact he sees and ways the behavioral healthcare system could improve even further. 

Listen to Dr. Ishant Rana’s podcast episode here. 

Building Experience and Understanding

Dr. Ishant Rana has practiced clinical psychology in India for over 13 years. He graduated from the National Institute of Mental Health and Neurosciences in Bangalore, India. He’s worked across a variety of focuses, including addiction, personality disorders, psychosis, depression, and anxiety. Dr. Rana joined Alpha Healing Center as Clinical Director, impressed with their multifaceted programs and respectful, non-stigmatized approach to care.

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Alpha Healing Center combines medical and psychological care, helping clients safely detox and receive the mental healthcare they need. They use advanced services like neurofeedback and repeated transcranial magnetic stimulation (rTMS) to heal addiction’s underlying causes, all while providing comfortable living spaces and an atmosphere of support and camaraderie.

Making a Difference with Personalized Treatment And Education

Dr. Rana’s work at Alpha Healing Center leverages multiple forms of therapy, medical services, and holistic practices to create personalized care plans for each patient. Alpha Healing Center treats both addiction and underlying mental health concerns, helping Dr. Rana and his colleagues provide the comprehensive care needed. 

Dr. Rana believes everyone needs and deserves help, especially people with substance dependence who may otherwise be seen as “too difficult.” His work at Alpha Healing Center allows him to provide the compassionate care needed to overcome stigma and impose the empowering possibility of recovery. He’s found psychoeducation to be a particularly powerful tool in disputing stigmas around addiction, including myths like:

  • Addiction is caused by a lack of willpower; enough willpower treats addiction
  • Relapses mean treatment failed
  • Someone with an addiction must also have a personality disorder

Science-backed truths educate patients and their loved ones, helping them heal as a unit.

Future Directions and Hope for Communities

As Dr. Rana outlines in his podcast episode, accurate addiction education can benefit both the person suffering and their loved ones. Psychoeducation teaches the truths about addiction and mental health conditions, helping communities view those with addiction in a more helpful light. Rather than being shunned or disgraced, those with addiction could instead receive support and encouragement to attend treatment. 

Fortunately, this is already happening in India and worldwide, especially as younger generations set the standard for mental health awareness and non-stigmatized care. As families and individuals learn more about addiction, they become more equipped to support their loved ones and pursue treatment with hope compassionately. Dr. Rana says,

“So people are getting better, they’re learning more, but I think we have to go a long way,” says Ishant.

Like recovery itself, education and awareness are journeys. Practitioners like Ishant Rana and Alpha Healing Center combat stigma and change viewpoints in hundreds of lives through their caring, evidence-based care, creating an approach that leaves a lasting impact.

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What Are Eating Disorders? Types, Symptoms, and Treatment

Eating disorders are illnesses defined by disturbances in eating patterns1 and food intake. They also include a preoccupation with body image, calories, and weight. People of any age, sex, gender, and background can develop an eating disorder. Someone with an eating disorder (also called ED) may avoid certain foods or restrict their diet, exercise excessively, use laxatives, or vomit after eating. 

Eating disorders are often an expression of the emotional pains in conditions like depression, trauma, and anxiety. Someone may develop an ED as a way to punish or gain control over themselves. Eating disorders can also develop due to genetic predispositions and social factors. Someone with an ED runs a higher risk of physical health complications, mental health decline, death, and suicide. 

A blend of therapy, weight restoration, and nutritional counseling can not only treat symptoms of an eating disorder, but heal its underlying causes for life-long recovery.

Listen to our podcast to learn more about eating disorder and addiction recovery from Recovery.com’s Chief of Staff, Amanda Uphoff. 

What Are The Causes of Eating Disorders?

Multiple factors can cause eating disorders1, including genetic predispositions, peer influence, mental health conditions, and bullying. Behaviors and personality dispositions can also lead to an eating disorder and affect what types of eating disorders may develop.

Types of Eating Disorders

Eating disorders take many forms, from restricting diets, purging, and a blend of both. Healing exists for each kind of eating disorder and its potential health complications.

Anorexia Nervosa

Anorexia nervosa causes someone to restrict their food intake2, exercise compulsively, and intensely fear weight gain. Someone with anorexia will often have a distorted body image, leading them to feel constantly overweight and in a pursuit of thinness. Anorexia has a very high mortality rate compared to other mental illnesses due to the health effects of emaciation (extreme thinness) and risk for suicide.

Anorexia is more common in females2 and occurs most often in adolescence or early adulthood. Someone with anorexia often won’t recognize their low weight, which can make it difficult for them to understand the severity of their condition and agree to treatment. As they progressively lose weight, severe health complications and other symptoms can arise, including:

  • Feeling cold all the time
  • Irregular periods or no periods at all, which can lead to infertility
  • Constipation
  • Tiredness and fatigue
  • Low and irregular heart rate
  • Shallow breathing or feeling out of breath
  • Dry skin and brittle nails
  • Bone thinning
  • Organ failure
  • Heart and brain damage

Co-occurring conditions like depression and anxiety often contribute to the development of anorexia2, as does growing up overweight, having parents or blood relatives with anorexia, and being body shamed by peers or loved ones. Suicide is the second leading cause of death for people with anorexia1, following death from health complications caused by undereating and excessive exercise.

Early intervention, weight restoration, and therapy can reverse the effects of anorexia and teach the coping tools needed for long-term recovery, helping patients navigate day-to-day stressors and heal their relationships with food—and themselves.

Bulimia Nervosa

Bulimia nervosa is defined as a pattern of binge eating and purging3. Binge eating involves eating large meals or many high-calorie foods in one sitting, often with the inability to stop. Purging is used to compensate for the binge and prevent weight gain. Someone may purge through self-induced vomiting, using laxatives, excessive exercise, or fasting. Binge-purging can quickly become a self-feeding cycle.

Bulimia nervosa occurs most commonly in young women1. It can develop due to brain abnormalities, social influence, and mental health conditions. Bulimia can lead to weight loss and symptoms like:

  • Irregular periods
  • Throat and mouth pain from the stomach acid in vomit
  • Tooth damage and erosion, also from stomach acid
  • Stomach pain and bloating
  • Fatigue
  • Dehydration from purging
  • Imbalanced electrolytes

Unlike anorexia, someone with bulimia may not appear underweight; they can even look overweight. That’s why clinical evaluations and examinations are important for diagnosis and treatment of bulimia. A doctor will check their patient’s vital signs, ask questions related to binge or purging behaviors, and check for inflammation in the mouth and throat to diagnose bulimia nervosa and start treatment.

Therapy can address the underlying causes of bulimia and teach skills to manage binge-eating, while weight restoration and nutritional care can improve physical health.

Binge-Eating Disorder

Someone with binge-eating disorder will binge on food, but not purge afterwards1. Binge-eating often includes a lack of control and inability to stop eating, which can cause someone to eat large meals. They may feel sick after binging and gain weight over time, potentially becoming obese. 

Binge-eating disorder can affect men and women of all ages. It can lead to extreme weight gain, shame, and secretive habits to conceal binging behaviors. Other symptoms include:

  • Eating very quickly
  • Eating despite feeling full or not hungry
  • Stomach pain due to overeating
  • Eating alone or in a secret location to hide eating habits
  • Lying about eating habits
  • Frequent dieting to try to control weight gain
  • Bloating

Therapy can help someone with binge-eating disorder learn to control binging and find comfort in other activities. Personalized eating plans and exercise regimes can also reduce weight at a safe, comfortable pace.

Avoidant/Restrictive Food Intake Disorder (ARFID)

ARFID causes avoidant or restrictive eating habits4. Someone with ARFID may avoid certain food groups, like carbs, or specific foods, like ice cream. They may also restrict their eating and not meet their required calorie intake. ARFID differs from other eating disorders in that body image and fear of weight gain don’t contribute to food habits; rather, someone may avoid or restrict food simply because they don’t like it.

ARFID was commonly thought of as a childhood disorder, like a more severe version of picky eating. But physicians saw adults experiencing symptoms too, and moved to shift the diagnosis to both children and adults. 

Symptoms of ARFID include:

  • Avoiding food groups or types of food suddenly and dramatically
  • Eating much less than usual
  • Eating fewer and fewer foods because they no longer sound appetizing
  • Weight loss
  • Reduced interest in food and meal times
  • Low/no appetite
  • Stomach and digestive problems

Treatment for ARFID often includes therapy to work through food avoidance and identify foods someone will enjoy eating. Weight restoration and nutritional care may be needed, but not always. 

Other Specified Eating or Feeding Disorder (OSFED) and Unspecified Feeding or Eating Disorder (UFED)

You can think of OSFED as a mix of eating disorder symptoms5 that don’t fall under anorexia nervosa, bulimia nervosa, or binge-eating disorder. A patient with this diagnosis may partially meet the requirement for one or more ED diagnoses. OSFED recognizes disordered behaviors and negative relationships with food as a hindrance on daily living, mental health, and physical health.

Similarly, UFED encapsulates eating disorder behaviors and symptoms that may not have a distinct classification. Some scholars and physicians debate the helpfulness of UFED and OSFED5, and instead suggest a singular term of ‘mixed eating disorders’. This term could offer more clarification for those diagnosed with it.

The symptoms of OSFED and UFED can vary widely, but typically include:

  • Restrictive diets; not eating certain foods
  • Purging behaviors (vomiting, excessive exercise, using laxatives)
  • An obsession with size and weight
  • Body dysmorphia

Therapy and possible weight restoration can help someone with OSFED or UFED heal short and long-term.

Pica

Pica is defined as eating non-food items or substances6, like mud or chalk. To diagnose, the person must be older than 2 and eating non-foods outside of cultural or societal norms. Pica can accompany disorders like schizophrenia, obsessive compulsive disorder (OCD), or trichotillomania (compulsively pulling out hair). It commonly occurs in intellectually impaired patients, children, and pregnant women. One study found 28% of pregnant women experienced pica6 during their pregnancy. 

Pica doesn’t have a direct cause6, though it’s been theorized that iron and zinc deficiencies can cause cravings for non-foods7. Pica can also be fueled by curiosity—most people may wonder about eating non-foods or want to, but they realize they shouldn’t. Intellectually impaired people and children may lack this reasoning and eat non-foods regularly. Children may also resort to non-foods to survive in neglectful or abusive environments.

Common pica ‘foods’ include:

  • Dirt and clay
  • Ice
  • Charcoal
  • Coffee grounds
  • Eggshells
  • Paper
  • Flaking paint (which can lead to lead poisoning)
  • Rocks, bricks, and cement
  • Plastic (plastic bags, containers, chunks)

Rumination

Rumination syndrome describes habitually regurgitating food8 and swallowing it or spitting it out. It usually happens 10-15 minutes after eating and can last up to two hours. Unintentional stomach and diaphragm tension can cause regurgitation. It happens without nausea and retching, but can cause stomach pain. Once someone learns how to do it, it can become habitual, like burping.

Symptoms of rumination syndrome include:

  • Weight loss
  • Malnutrition
  • Teeth erosion
  • Electrolyte imbalances
  • Abdominal pain

Rumination can co-occur with conditions like depression, anxiety, obsessive compulsive disorder (OCD). It can be a symptom of an eating disorder or occur alongside one. Treatment often includes breathing exercises to relax the diaphragm, behavioral therapies, and other relaxation methods to practice after meals. Staying relaxed can prevent the over-tightening of the stomach and diaphragm that allows rumination.

Treatment for Eating Disorders

Eating disorder treatment1 often includes a blend of behavioral therapies, nutritional counseling, medically supervised weight restoration, and medications. Treatment aims to address the ED’s symptoms and underlying causes, like anxiety, stress, depression, or trauma. Therapists work in 1:1, group, and family settings to help patients heal their relationship with food, navigate co-occurring conditions, and develop a relapse prevention plan.

Behavioral Therapies for Eating Disorders

Cognitive behavioral therapy (CBT) for eating disorders1 addresses binging, purging, and restrictive behaviors. It teaches coping tools and helps patients identify and change untrue beliefs about food, their body, and self-image.

Dialectical behavioral therapy (DBT) helps in similar ways, but focuses more on accepting thoughts and emotions and living with their potential discomfort—without restricting, binging, or purging. It centers on mindfulness, helping patients experience emotions without trying to change or limit them.

Behavioral therapies often occur alongside medications (like antidepressants or antipsychotics), medical care, and nutritional counseling.

Medical Care and Monitoring

Medical care may take place in an inpatient or outpatient setting, depending on each patient’s presentation and how underweight they may be. Weight restoration aims to safely restore weight until patients reach a healthy base weight. It focuses on physical health and safety, but restoring weight can also restore cognitive functioning.

Weight restoration9 can be done via feeding tube, nutritional supplements, and meal monitoring to ensure patients eat full meals. Other medical services may include heart monitoring, medications, and potential life-saving measures in the case of heart failure or other organ failures.

In an inpatient setting, patients receive 24/7 care and monitoring. This may be necessary for severely underweight patients and/or those who refuse to eat due to an eating disorder. Nurses and clinical staff monitor vital signs and track weight. In an outpatient setting, care and monitoring may be available, but not 24/7. This can fit the needs of someone at a stable weight, but needing ongoing therapeutic care and monitoring.

Nutritional Counseling

In nutritional counseling, a certified nutrition counselor assesses current eating habits10 and identifies dietary changes. They help create meal plans, educate on the importance and effects of good nutrition, and help patients with eating disorders change how they view food. For example, they may explain the benefits of feared food groups and “fear foods” to lower the fear and negative associations someone may have.

Nutritional counseling can disprove untrue beliefs or fears about food and help patients feel more comfortable eating new/more foods, complementing behavioral therapies and  weight restoration.

What to Expect When Seeking Treatment

What happens when you seek treatment for an eating disorder? It varies for everyone, but you can expect your appointments with therapists and medical providers to follow general structures.

Medical Providers

You’ll typically meet with your primary care physician (PCP) first to start the treatment process, then see specialists at their referral. In this initial appointment, you and your doctor will discuss what you’ve been experiencing and struggling with. Based on your discussion, you can ask questions like:

  • Do my symptoms meet the diagnostic criteria for an eating disorder?
  • What treatment do you recommend?
  • What level of care do you recommend for my symptoms and their effect on my life?
  • What can I do to take care of myself at home?
  • Will I be put on medication? Which one, and what are its side effects?

Your doctor will likely provide physical evaluations, checking your mouth, throat, stomach, and your heart rate, among other vital signs. These evaluations can reveal and confirm health concerns, potentially leading to additional lab testing or other functional tests. Your doctor will use the results of their evaluations to determine the best next steps for you.

At the end of your appointment, you’ll likely leave with referrals to specialists, therapists, or a plan to start intensive care in an inpatient or outpatient setting. In severe cases, a PCP may send you directly to an emergency room.

Therapists

Your first therapy session for eating disorder recovery often covers your history with eating disorders and general information about yourself. You’ll talk about what brought you into treatment, and depending on how much time you have, you may take assessments to help your therapist better understand your mental state and personality. Future sessions cover current and past issues more in depth, focusing on the thoughts and beliefs behind eating disorders, identifying triggers, and learning coping tools.

Overall, think of your first session as your therapist getting to know you, and you feeling comfortable with them. If you don’t find the right therapist on your first try, that’s okay. You’re encouraged to connect with new therapists if your current one doesn’t feel like the right fit. 

Lifestyle Strategies and Habits to Manage Eating Disorders

Lifestyle changes and new habits can help manage eating disorders. Remember to seek professional treatment as your first step in recovery, using new habits and lifestyle changes to complement your recovery and form your relapse prevention plan. 

Prioritize Good Sleep

Good sleep can help your mind and body work their best. This benefits your recovery and well-being as a whole. Try these tips to improve how long you sleep and your sleep quality:

  1. Create a nighttime routine that you enjoy and look forward to—purposefully wind down and prepare for sleep the same way each night to train your brain.
  2. Make sure your bedroom is a calm space focused on sleep. Don’t use it to work, eat, or scroll social media.
  3. Dim your lights an hour or longer before bed to trigger your natural circadian rhythm and make you feel sleepier.
  4. Get sunlight in the morning and evening, ideally the sunrise and sunset. You could take morning and evening walks, or sit outside on your porch to view and feel the sun. This can regulate your circadian rhythm.

Practice Stress-Reduction Strategies

Effective stress reduction strategies can vary person-to-person. You can identify what works for you in therapy, or you may already know from past experience. Keep one or two methods in mind to use as-needed, or work some of these examples into your weekly schedule: 

  • Drawing
  • Meditation
  • Talking to a friend or loved one
  • Journaling
  • Baking or cooking
  • Knitting, crocheting, or sewing
  • Taking a walk
  • Spending time in nature

Build and Connect With Support

Connect often with your support network as you undergo treatment, walk your recovery path, and live in long-term recovery. Your support network could include family, friends, and people at your work or place of worship. Keep them up-to-date on your treatment journey and how they can support you.

Friends and family can offer their support and keep you accountable. For example, they may catch or point out potential behaviors you’ve reverted back to, or new habits that could lead to an ED recurrence. 

Find Eating Disorder Treatment

Treatment for all types of eating disorders is an essential start in recovery. A personalized blend of therapy, nutritional counseling, and medical care can restore physical health and heal underlying causes and conditions. You can hear a first-account story of eating disorder recovery by listening to the episode with Amanda Uphoff on Recovery.com’s podcast.

To find eating disorder treatment, you can browse our list of treatment providers and compare services, pricing, and reviews to find the best center for your or a loved one’s needs. 

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Challenges in Education: COVID-19, Addiction, and Mental Health

Newer generations have had to hurdle many new challenges in their education—a global pandemic, a rise in school violence, and an unmet demand for mental health and addiction treatment. COVID-19, in particular, completely shifted how school and socializing worked, and many students still feel those effects. 

These challenges have brought a rise in mental health and addiction struggles in teens despite their resilience and desire for treatment. Fortunately, students and their families have many resources for healing. Dr. Dana Battaglia highlights some of these resources in our recent podcast episode; listen here.

Stats on Addiction in School-Age Kids

Kids and teens often experiment with substances like alcohol and tobacco. “Study drugs” like Adderall often pass hands1 during finals or other testing seasons. School can be an easy place to get and distribute vapes, marijuana, and “hard” drugs like cocaine. Alcohol is the most commonly used and abused substance2 among teens, followed by marijuana and tobacco products. Here are the stats at a glance:

  • 61.5% of teens have overused alcohol by their senior year
  • In 2022, 407,000 teens 12-17 years old met criteria for alcohol use disorder
  • 35.2% of teens smoked or vaped marijuana in 2022
  • 788,000 teens ages 12-17 met criteria for illicit drug use disorder in 2022 (1-in-8 teens)
  • Half of teens have misused a substance once or more

Between 2016 and 2020, the rate of 8th graders taking drugs went up 61%. One in 8 teens abuse drugs, making youth drug use a major public health concern2. Not only does substance use damage their health and well-being, but it can also impact their ability to do well academically and advance to college. 

Social acceptance and peer pressure could initiate substance use. For example, teens may feel pressured to drink at a party to fit in and not seem like a ‘downer.’ Drinking in these situations can progress into drinking in other situations, like casual hangouts with friends or even alone in their room. 

Similar to alcohol, vaping has been normalized among teens, leading to a reported 2.1 million teens using vapes in the U.S3. Well over half of teens want to quit but haven’t had successful attempts. Starting tobacco use as a teen often leads to continued use in adulthood.

Mental Health Stats in School-Age Kids

Mental health conditions, especially untreated, can also impact students’ abilities to succeed in school and maintain their well-being. Mental health conditions can also lead to substance use4 as a coping mechanism, potentially leading to addiction. These are some stats on mental health conditions in students:

When mental health conditions affect a student’s ability to learn, they’re classified as having an “emotional disturbance.” Having an emotional disturbance makes students eligible for an individual education program6 (IEP), which offers more personalized education services and catered support services to help students succeed. However, few students get this important support. Many schools and teachers don’t have the resources to care for these students, leading to more suspensions and removals. 

Solutions center around seamless, integrated care—mental health support, educational support, and parental support all in one place: school. 

Impact of COVID-19 on Teen Education and Well-Being

Lockdowns during the COVID-19 pandemic changed how teens and children got their education, socialized, and learned. Many lost out on major milestones like graduation and prom. In-person classrooms became Zoom meetings on small Chromebook screens. As schools and educators adapted for virtual learning, new problems took root. 

A survey done by the Center for Disease Control7 reported these findings:

  • Of U.S. high school students, 67% felt like schoolwork got harder
  • 55% suffered emotional abuse at home
  • 11% suffered physical abuse
  • 24% didn’t have enough to eat during the pandemic

Adding in isolation and loneliness, these factors could strongly impact learning and teen mental health. Students also reported excessive homework and assignments8, lack of motivation, and difficulty with finding a balance between school and life. Those who needed extra help in the classroom lost access to the in-person, 1-1 attention required to help them stay on track. 

Students also lost the vital social interactions offered in a classroom. One student says9, 

“Learning without the social cues of a classroom was difficult. At in-person school, I took notes when I could see that everyone around me did. During Zoom, I didn’t know what I was supposed to be doing.” 


The National Center for Education Statistics found that in 2022, 9-year-olds scored lower in both reading and math10 compared to 2020. Reading scores saw their biggest drop in over 30 years, and math scores went down for the first time ever recorded. These changes happened because of COVID-19 disruptions like school closures and virtual learning. Despite these challenges, teachers, parents, and communities helped support students and prevented scores from falling even further. The same student from above echoes that, saying,

“People adapt and become stronger even with uncertainty. I can deal with it too.”

Preventative Measures and Available Resources for Healing

Students with mental health conditions, whether influenced by COVID or not, have multiple resources available for healing. But they often don’t know they’re there. 

Overwhelmed schools and staff can rarely provide the awareness many students need to know they have resources available, like access to school counselors, therapists, and state-funded mental health programs. Adequate awareness of these resources could help students access crucial mental health and addiction support before issues affect their learning and well-being. 

Students can also access resources outside of school, like therapy, intensive outpatient programs, or youth-focused crisis services. Many crisis services focus specifically on youths and certain demographics, like LGBTQ+ teens. Here are a few lines you can call or text:

  • TrevorLifeline: help for LGBTQ+ young adults needing support. Text 678678, call (866) 488-7386, or chat with them online.  
  • Hey Sam: peer support for people up to 24 years old. Text 439-726 from 9AM to 12AM ET and talk about anything on your mind.
  • Teen Line: support and resources for teens offered by highly trained volunteers. Call (800) 852-8336, text 839863, and chat online.

Future Goals and Ideas

Students showed resiliency through the COVID-19 pandemic and day-to-day struggles with mental health conditions and addiction. Gen Z takes an active stance in reducing their likelihood of addiction by drinking less11, up to 20% less than Millennials. Wellness trends, better awareness on mental health and addiction, and viewing mental health as important as physical health add up to make an inspiring impact.

Encouragement from schools, parents, and peers to maintain this momentum could reduce addiction and related mental health conditions in an entire generation. 

More mental health staff at schools could support this positive change and extend it to younger generations. For example, a school may employ a social worker for every grade who can provide in-the-moment crisis support, connect students to available care options, and educate parents on the support needed. 

Schools could also change or reduce punishments for substance use. As an example, catching a student vaping or drinking on-campus could automatically enroll them in an educational after-school program rather than a suspension. Mandatory education on drinking, drug use, and mental health conditions could also teach students the dangers of substance use and prevent addiction before it starts.

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Sober Curious: Exploring a Life Beyond Alcohol

The sober curious movement is reshaping how people view and consume alcohol. Many are questioning the role of alcohol in their lives, which encourages a reflective look at drinking habits and the potential benefits of reducing or abstaining from alcohol altogether. 

This growing curiosity stems from various motivations, ranging from health concerns to a deeper desire for mindfulness and authenticity in social interactions. Explore if a sober lifestyle is right for you.

Introduction to the Sober Curious Movement

The term “sober curious” was popularized by Ruby Warrington in her 2018 book Sober Curious, which explores a life lived better without alcohol. Rather than focusing on complete abstinence for those with dependency issues, this movement invites everyone to assess their alcohol consumption critically. It has gained traction among people who don’t identify as having an alcohol problem yet feel alcohol doesn’t need to be central in their social lives.

The growing buzz around “sober curious” reflects a trend to reevaluate people’s relationship with alcohol and explore a life beyond its consumption. Curiosity and mindfulness towards alcohol consumption prompts individuals to question societal norms around drinking and consider the impact of alcohol on their physical, mental, and emotional well-being. 

Why People Choose the Sober Curious Path

Research shows that lifestyle behaviors, including alcohol consumption, play a significant role in overall health and well-being. Creating a balanced lifestyle may inspire people to cut back on alcohol, and, as they do so, make other positive changes. Healthy lifestyle choices, such as low to moderate alcohol intake, physical activity, adequate rest, and a balanced diet, can reduce the risk of cardiovascular diseases, cancer, and other health conditions1. Drinking less can also help alleviate mental health symptoms like anxiety and depression2. 

In addition to lowering alcohol intake, the sober curious movement explores alternative ways to socialize, relax, and unwind. Alcohol-free social events, mocktails, and wellness activities that promote holistic well-being help people connect and socialize while sober3. By embracing sobriety as a conscious choice rather than a restriction, you can be empowered to prioritize self-care and mindfulness in your daily life. 

Alcohol can often mask or complicate feelings, and being sober allows you to fully experience your emotions and deal with them in a healthier way. Practices such as meditation and yoga, which emphasize mind and body clarity, can promote overall well-being in those exploring abstinence. 

Benefits of Being Sober Curious

Physically, sobriety or lowered alcohol consumption can lead to better sleep, weight loss, and reduced risk of chronic diseases4. However, its benefits go far beyond the physical. 

Alcohol can exacerbate mental health issues like anxiety and depression2. Sobriety often brings a greater emotional balance and can make it easier to handle stress and other emotional challenges. It also allows for more genuine emotional experiences, providing better ground for processing feelings in a healthy way. Without the clouding effects of alcohol, sober individuals may think clearer and have better concentration. This can translate into improved decision-making skills and productivity, both personally and professionally.

The sober curious movement also helps people live authentically. The decision to reduce drinking links to overall wellness, authenticity, and personal growth5. Choosing to be alcohol-free can help you live in alignment with your goals and desires.  

Challenges and Considerations

Transitioning to a less alcohol-centric lifestyle can be a positive and transformative journey, but it often comes with its own set of challenges. In cultures where socializing often revolves around drinking, it may take time to figure out what strategies and situations are most beneficial.

One of the most common hurdles is the social expectation to drink at events, gatherings, or even during business meetings. This can make it difficult to abstain, as people may feel left out or judged by others who drink. For those who regularly drink, cravings can be a significant challenge. These cravings can be both physical and psychological, making the initial period of sobriety particularly tough. For many, simply pouring a drink and bringing the glass to their lips can give a dopamine hit6 (instead of the alcohol itself) that’s hard to let go. 

Alcohol is often at the center of a social gathering, and over time, many begin to equate drinking with bonding, community, and inclusion7. For example, certain drinking games can make you feel like you are part of the party. But when surrounded by the right people, you won’t need alcohol to feel loved and accepted.

Alcohol can also mask social anxiety or other concerns. Fortunately, as you explore a healthier, alcohol-free lifestyle, other tools can also help you overcome this coping mechanism. 

How to Embrace a Sober Curious Lifestyle

Exploring sobriety can be fulfilling, and adopting practical strategies can make the transition smoother and more sustainable. Here are some tips for those interested in reducing their alcohol consumption or becoming completely sober:

  • Mindful drinking: Before drinking, decide how many drinks you will have and stick to that limit. You can also slow down your drinking, which can help you be more aware of the effects of alcohol on your body.
  • Alcohol-free alternatives: Keep a variety of alcohol-free drinks at home, such as mocktails, non-alcoholic beers, sparkling waters, and teas. Many restaurants and bars also offer non-alcoholic beverages.
  • Plan ahead for social events: When attending social gatherings, bring your own alcohol-free drinks so you’ll have something to enjoy. You may also find it beneficial to have a simple response prepared when someone asks why you’re not drinking. You could say, “I’m choosing not to drink because it makes me feel healthier.”
  • Explore new hobbies and interests: Take up hobbies not associated with drinking, such as sports and arts and crafts. This can be a great way to make new, potentially sober, friends.
  • Support networks: You can inform your friends and family about your decision to reduce alcohol consumption so they can provide a supportive environment. Also, many online forums and social media groups focus on sobriety, which can provide inspiration, resources, and a sense of community. You may consider groups like Alcoholics Anonymous, SMART Recovery, or other local sobriety support groups where you can share experiences and receive encouragement.

Reducing alcohol consumption is a process, and it’s okay to have setbacks. Reflecting on your experiences, feelings, and challenges can help you adjust your goals and recognize the benefits of reducing alcohol. Treat yourself with compassion and consider each step part of a learning curve to achieve your desired lifestyle.

The Impact of the Sober Curious Movement on Society

The sober curious movement has the potential to challenge societal norms around alcohol consumption and reduce the stigma associated with not drinking. It’s also influencing the beverage industry to innovate more non-alcoholic options. 

By promoting open conversations about alcohol and encouraging individuals to make informed choices about their consumption, this movement fosters a culture of inclusivity and acceptance5. It provides a supportive community for those exploring sobriety or seeking a healthier relationship with alcohol. This movement also makes social gatherings more inclusive for those who choose to abstain.

These changes reflect a broader cultural shift towards wellness and conscious consumption, potentially leading to significant public health benefits including lower rates of alcohol-related diseases and accidents.

Creating a Healthy, Fulfilling Lifestyle

The sober curious movement invites you to rethink your relationship with alcohol and consider the benefits of reducing or eliminating alcohol from your life. It’s an opportunity for personal health transformation and a catalyst for broader societal change. Whether for physical well-being, mental clarity, or improved relationships, exploring a sobriety can be a rewarding and enlightening journey.

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The Necessity of Seamless Care in Improving Education: Insights from Dr. Dana Battaglia

We were honored to talk with speech-language pathologist, educator, and TEDx speaker Dr. Dana Battaglia on our recent podcast episode. Hosted by our Editor-in-Chief and clinical psychologist, Dr. Malasri Chaudhery-Malgeri, we discussed the special education system as a whole, where it can improve, and resources for parents.

Tune into this episode for a deep dive into adolescent mental health, how schools navigate their ever-increasing needs, and how seamless mental health and learning support can help students thrive.

Listen here on your favorite podcast platform.

Bringing Experience and Passion to Special Education

Dr. Dana Battaglia is a wife and mother passionate about effective communication and equal-opportunity learning. 

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To the special education system, she brings vast knowledge and experience with literacy disabilities, autism spectrum disorder, and communication. In her current work as Chair of the Committee on Special Education at the Westbury Union Free School District, she determines if students have a disability. To have a disability, students must fall under one or more of the 13 educational classifications, which include autism, emotional disorders, and speech impairments. Dr. Battaglia has worked as an Associate Professor and Clinical Coordinator at the Genesis/Eden II Programs.

Reactivity vs. Proactivity in Special Education

Dr. Battaglia outlines the need for proactive care, saying, “…by the time they get to me, a student is really in disarray if they truly do have a disability.” Students come to her only after they’ve experienced academic difficulties, which then gets treatment rolling.

However, Dr. Battaglia notes that the system has improved in the last twenty years. Mental health is recognized as an important aspect of student health, opening up doors to comprehensive treatment for both students and their parents. But by the time students have their needs recognized, their well-being and academic success have often already been affected.

Rising Mental Health Needs and Emotional Disabilities

Mental health conditions and diagnosed emotional disabilities have been on the rise, Dr. Battaglia notes. She sees literacy disorders leading to addiction as a means to cope with academic stress. COVID-19 has also created spotty, inconsistent education and classroom experiences, causing some students to fall behind socially and academically. 

Due to increased need, students who experienced sexual assault and abuse encounter long waiting lists for more intensive therapeutic environments. General mental health care often bumps into the same problem—unmet demand and wait times. 

Resources and Help Where Students Need It Most

Partnerships with clinics, psychiatrists, state programs, and community resources actively meet the needs of students with mental health conditions and learning disabilities. Though wait times and incongruent care can delay treatment, it is available and often highly effective. Asking for help is the first and most vital step. Dr. Battaglia says,

“What I have said to families is that in my 25-plus years of practice, I have never, ever seen a child die from an extra evaluation. Or getting extra therapy that maybe they didn’t need.”

Schools can offer help through on-site counseling and academic support, creating individualized education plans. They can also refer students to outside treatment to connect them to more effective and fast care. School staff and psychologists conduct home visits to ensure student safety, provide in-home instruction, and provide other forms of support to care for their students, including Parent Training and Consultation programs.

Support for Families

Parents have resources available to them, too. Parent Training and Consultations equip families with essential tools to support their children’s educational needs and treatment goals. Family groups connect parents and offer a space to share encouragement, which schools can connect parents to.

Solutions in a Dream World: Seamless Care 

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Dr. Dana Battaglia envisions seamless, integrated care in all schools and for all students. Each school would have psychologists, psychiatrists, social workers, speech pathologists, and special education instructors. Attentive care would identify mental health and learning challenges before they disrupt academics and a student’s overall well-being. Translators would be available for students of different cultures and countries, helping them assimilate into the classroom and new cultural expectations. Dr. Battaglia says,

“I would love to see a world where a teacher has opportunities to collaborate with a literacy specialist and a speech language pathologist, embedded in their day, with counseling support.”

Overall, students wouldn’t rely on a school’s limited resources and referrals to get treatment. Therapeutic treatment would instead take place where students already spend most of their time—at school. The first line of defense, though straggled now, would become more robust and capable of handling rising demands. 

With continued government support, this dream may soon become a reality, especially as educators and treatment professionals continue to advocate for their students’ well-being. 

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Mastering Relapse Prevention Planning: Your Guide to Sustained Recovery

Addiction recovery is a journey that extends beyond initial treatment, involving continuous commitment and proactive planning. Relapse prevention planning helps maintain long-term recovery by identifying potential triggers and creating actionable responses. This approach strengthens recovery for substance use disorders, behavioral addictions, mental health concerns, and other conditions. 

Our comprehensive guide outlines relapse prevention planning’s key components and practical steps for creating and implementing an effective plan.

Understanding Relapse Prevention

Relapse prevention planning helps people in recovery avoid relapse—which means using substances after a period of abstaining or reverting to unhealthy habits and thought patterns in mental disorders. Relapse prevention is a critical component in managing conditions1 like major depressive disorder, anorexia nervosa, substance use disorders, and other medical conditions. 

Relapse doesn’t always occur overnight. There are complex signs and precursory emotional, mental, and physical phases2. Emotional relapse begins with anxiety, anger, or isolation. Mental relapse involves cravings, minimizing consequences of the past, bargaining, lying, and planning a relapse. Then, the physical relapse happens: drinking again, refusing to eat, lapsing into a severe depressive state, etc. 

Not everyone in recovery will relapse, but it is often a part of the recovery process3—and that’s okay. Relapse prevention can help you address these obstacles and keep you on the right track.

Relapse prevention planning aims to recognize and address these signals before they escalate to the physical stage. It utilizes a cognitive behavioral approach to prevent a relapse and provide appropriate skills on what to do if a relapse does occur. Relapse prevention is usually a combination of education, coping strategy development, trigger identification, building support networks, and lifestyle changes. Each plan is tailored to meet personal needs.

The Components of a Relapse Prevention Plan

An effective relapse prevention plan covers multiple life facets. Essential components of a relapse prevention4 include:

  • Identifying triggers: Internal and external cues can be emotional (such as stress or anger), physical (such as fatigue), or environmental (such as certain social situations or locations). Recognizing these helps in strategizing how to manage or avoid them.
  • Coping skills: Effective coping strategies can help you deal with triggers before they cause a relapse. These strategies could include skills like deep breathing, mindfulness, or other stress management techniques. Additionally, you’ll learn skills to refuse offers of drugs or alcohol and strategies to escape high-risk situations.
  • Enhancing self-efficacy: Throughout relapse prevention planning, you are encouraged to make choices and contribute ideas to your recovery actively. Your care team may emphasize that recovery is not about willpower but rather skills acquisition. Empowerment from professionals can help you take charge of your future and well-being, fostering sustainable recovery. 
  • Psychoeducation: Understanding the nature of addiction, mental health disorders, and relapse, including its biological, psychological, and social aspects, helps in managing it effectively. 
  • Healthy routine: Maintaining daily healthy routines supports overall well-being and reduces the likelihood of relapse. You’ll find balance in regular exercise, a nutritious diet, adequate sleep, and engaging in healthy, sober hobbies. 
  • Support systems: You and your therapist will create a plan to build a support network that includes friends, family, clinical professionals, and support groups. This network provides emotional support, accountability, and a safety net in times of crisis.
  • Emergency plan: If you feel close to relapsing, your care team can help you create a detailed emergency plan. This plan will outline who to contact, where to go for help, and what steps to follow to stay safe.

Recovery is an ongoing process, so having the right tools can help you manage addiction or mental health conditions. Sustainable healing is built by small, everyday efforts.

Building Your Personal Relapse Prevention Plan

Creating a tailored relapse prevention plan involves a detailed, personalized approach. 

Reflect on Your Recovery Goals

You’ll want to begin planning by writing about 3 key recovery components: 

  1. Reflect on your recovery history. In treatment, what worked and what didn’t work? If you’ve relapsed before, what led to it? What were your triggers before you got treatment? Learn from mistakes of the past to make a realistic relapse prevention plan.
  2. Write down personal, relationship, and employment goals to highlight situations you want to be in and people you want to be around. 
  3. Identify your triggers—all the people, places, and things that could cause stress. Developing coping strategies for each trigger can empower you to live life without fear.

Coping Skill Development

There may be times when you experience uncomfortable feelings and situations; however, with the right tools, you can navigate through these moments. You may practice coping techniques such as breathing exercises, regulating emotions through journaling, saying “no” to situations that do not serve your recovery, and exercise. This can help you walk into any situation with confidence. 

Continuing Therapeutic Care

Attending outpatient care or talk therapy sessions can help you navigate foreign situations and continue skill-building. During individual therapy sessions, you’ll likely engage in various therapeutic methods like dialectical behavior therapy (DBT) and acceptance and commitment therapy (ACT). 

You may also participate in support groups like Alcoholics Anonymous (AA) / Narcotics Anonymous (NA) and SMART Recovery. Peer support from those with similar experiences can maintain motivation in recovery5. Those healing from mental health concerns can find community in National Alliance on Mental Health (NAMI) support groups.

Structured Routine

Creating a daily routine that promotes physical and mental health, including regular exercise, balanced nutrition, and sufficient sleep, can bolster sustainable recovery6. A scheduling system, such as time blocking in a calendar, can help you avoid idle time that might lead to thoughts or behaviors associated with relapse.

Support Systems

Creating a support network with strong relationships is a foundational aspect of long-lasting recovery. Social support in recovery can reduce stress, increase self-efficacy, and motivate sobriety or remission7. Your relapse prevention plan can detail how you will connect with loved ones who supported you through the treatment process. You may make new friends through sober activities and groups. Try your best to plan regular get-togethers with friends and family, as avoiding isolation and bolstering these relationships can make recovery easier. 

“The opposite of addiction is connection.” –  Johann Hari

Emergency Plan and Contacts

In case of emergency, have a clear plan with proactive steps, such as calling a specific person, attending a support group meeting, or going to a safe place. You can keep a list of emergency contacts, including supportive friends, family, and healthcare providers.

Implementing Your Plan

A relapse prevention plan can be broken down into small, manageable steps. You can begin each day with a consistent morning routine that includes healthy, pro-recovery activities such as meditation, reading, exercising, or journaling. This sets a proactive, positive tone for the day and reinforces your commitment to recovery.

You can keep a daily planner and include time slots for activities that support your recovery, such as therapy sessions, support group meetings, or time with friends and family. Planning helps manage stress and avoids the chaos that can lead to relapse. Your planner can also help you track exercise, meals, and sleep.

Stay connected with your support network through regular check-ins via phone calls, texts, or in-person meetings. These connections provide strength and accountability, crucial for everyday recovery maintenance.

At the end of each day, spend time reflecting. Assess what went well and identify any challenges you encountered. Use this reflection to adapt your plan and prepare for the next day.

Monitoring Progress and Making Adjustments

All progress should be tracked and celebrated. You can have regular check-ins with yourself and your care team to ensure you’re engaging in activities that suit your current recovery needs. What may have worked in the beginning of your recovery might not serve you years down the road. Try writing answers each month for questions such as:

  1. What were your main goals when you created your relapse prevention plan? How well do you feel these goals are being met?
  2. In what ways have you changed since leaving primary treatment? Consider your habits, thought patterns, emotional responses, and relationships.
  3. What are the most significant challenges you’ve faced during your recovery process, and how have you addressed them? How has your relapse prevention plan supported you in these challenges?
  4. What new coping strategies or skills have you learned through your relapse prevention plan? How effectively are you able to apply these in real-life situations?
  5. In what areas do you feel you still need to grow or improve? How can your relapse prevention plan or other resources assist you in these areas?

Common Challenges and How to Overcome Them

Relapse prevention planning aims to provide useful tools for navigating difficult moments in recovery. Anticipating potential obstacles and feeling confident in your ability to manage them can help you move through life optimistically. 

Often, those in recovery may feel overwhelmed at social gatherings, holidays, or certain places because they trigger cravings or old behaviors. One of the best ways to manage this is by simply choosing not to attend the event; however, this is not always possible. You can plan ahead by bringing a supportive friend, having an exit strategy, and preparing responses to offers of substances.

Uncomfortable emotions, such as stress and loneliness, are a part of life, and implementing skills from your relapse prevention plan can help mitigate the impact of these feelings. You may find engaging in mindfulness and relaxation exercises like meditation and box breathing helpful. Consistent exercise can help reduce negative emotions8 and the chance of relapse. Keeping in touch with supportive friends and family can help ensure you always have a shoulder to lean on.

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Sometimes, it’s challenging to explain to new friends why you choose to abstain from drugs and alcohol. This can happen with long-time friends and family members, as well. If this person ignores your reasoning and continues to pressure you, this may signify that they do not care for your well-being as much as you do. It can be hard to distance yourself from others but know that there are people who will support your recovery efforts. And a true loved one will only want you to engage in activities that benefit your health.  

Communicating Boundaries to Your Support Network

Setting and communicating boundaries in recovery is important for your relationships and a practice of self-love. Without boundaries, you may say “yes” to things you don’t want to, avoid necessary conversations, and be consumed by others’ negative feelings. Prioritizing your boundaries ensures that you’re aligned with what’s best for your well-being.

Before communicating with others, take time to understand your own needs and boundaries. What specific support do you need? What behaviors or situations are helpful or harmful to your recovery? Being clear about these will help you articulate them more effectively to others.

Clarity is an act of kindness, so be honest and straightforward in these conversations with your loved ones. You can frame the conversation around “I” statements to express your feelings and needs without blaming others. For example, say “I feel overwhelmed when we talk about drinking at parties, and I need us to focus on other topics,” instead of accusing or blaming them. 

Stay consistent with your boundaries; this will help others respect them. Be sure to let loved ones know that you appreciate their trust. You can also encourage an open dialogue by asking for their thoughts and feelings about your recovery process. This can strengthen the relationship and make them feel involved and valued in your journey.

Ongoing Recovery and Maintenance

Maintaining recovery motivation is possible through small, concerted everyday efforts. It’s often easier to break down long-term goals into more manageable chunks, such as committing to a weekly support meeting and exercising 5x weekly. A recovery journal can document your thoughts, feelings, challenges, and successes. Reviewing your journal can visualize how far you’ve come and remind you why you started this journey.

A structured daily routine with adequate rest, proper nutrition, and movement can provide stability and reduce uncertainty. This can help manage stress and avoid situations where one might be tempted to relapse.

You can also learn new skills or hobbies to occupy your time, build self-esteem, and provide a sense of accomplishment. These new activities can serve as positive outlets for stress and boredom.

A day of sobriety is a day worth being celebrated! The effort to choose your health and well-being every day is a great feat, so continue to reflect and pride yourself on your hard work.