Internet Mental Health

ALCOHOL USE DISORDER






Expanded Quality of Life Scale For Alcohol Use Disorder

Internet Mental Health Quality of Life Scale

Big 5 Factors Of Mental Illness And Code For This Disorder
(The "6th Big Factor" of Mental Health, "Physical Health", Is Coded Normal or Green)

  • Alcohol use disorder is the continued use of alcohol despite clinically significant distress or impairment.

  • It typically includes a strong desire to take alcohol, difficulties in controlling its use, persisting in its use despite harmful consequences, a higher priority given to alcohol use than to other activities and obligations, increased tolerance, and a physical withdrawal state.

Prediction

    Episodic or continuous for years

Problems

Occupational-Economic Problems:

  • Causes significant impairment in academic or occupational functioning

  • Only a minority are so chronically disabled that they require a disability pension

  • Economic problems caused by squandering money or alcohol-related unemployment

  • Alcohol Use Disorder accounts for 9.6% of the disability caused by mental illness worldwide

Antagonistic (Antagonism):

  • Intoxicated behavior can be very uncooperative and disagreeable

Disinhibited (Disinhibition):

  • Intoxicated behavior, impaired driving

  • Impulsivity, dangerous risk taking, irresponsibility

  • Law-breaking, violence

  • Marital (or child) discord/abuse/neglect

Cognitive Impairment (Impaired Intellect):

  • Marked denial; lack of insight

  • Cognitive impairment when intoxicated

  • Chronic alcoholism can cause alcoholic hallucinosis, psychosis, amnestic disorder, delirium, or dementia

Negative Emotions (Negative Emotion):

  • Depressed mood, generalized anxiety, anger, suicidal behavior

Sociable (High Extraversion) OR Detached (Detachment):

  • Intoxicated behavior can cause, socially and sexually, either excessive disinhibition (being talkative and assertive) or inibition (being quiet and reserved)

Medical:

  • Alcoholism is the 3rd leading cause of death in the developed world.

  • Sort-term Consequences: automobile accidents, accidental injuries, accidental or deliberate overdoses, injuries and risky behavior, memory and concentration problems, coma, breathing problems, slurred speech, confusion, impaired judgment and motor skills, drowsiness, nausea and vomiting, emotional volatility, loss of coordination, visual distortions, impaired memory, changes in mood and behavior, and depression. Impaired judgment can result in inappropriate sexual behavior, sexually transmitted infections, and reduced inhibitions.

  • Long-term Consequences: impaired coordination; cardiovascular problems including heart muscle injury, irregular heartbeat, stroke, and high blood pressure; gastritis, ulcers; liver problems including steatosis (fatty liver), alcoholic hepatitis, fibrosis, and cirrhosis; pancreatitis; alcohol withdrawal seizures; peripheral neuropathy; alcohol-induced persisting amnestic disorder (Wernicke-Korsakoff syndrome); erectile dysfunction; increased risk of various cancers (including of the mouth, esophagus, larynx, pharynx, liver, colon, and rectum); weakened immune system; coma, and death due to alcohol overdose. For breast cancer, even moderate drinking may increase the risk.

  • Pregnancy-related: sudden infant death syndrome (SIDS), fetal alcohol spectrum disorders (FASD).



Explanation Of Terms And Symbols

Internet Mental Health Quality of Life Scale


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Click Here For Free Diagnosis

Limitations of Self-Diagnosis

Self-diagnosis of this disorder is often inaccurate. Accurate diagnosis of this disorder requires assessment by a qualified practitioner trained in psychiatric diagnosis and evidence-based treatment.

However, if no such professional is available, our free computerized diagnosis is usually accurate when completed by an informant who knows the patient well. Computerized diagnosis is less accurate when done by patients (because they often lack insight).

Example Of Our Computer Generated Diagnostic Assessment

Alcohol Use Disorder (Alcoholism) 303.90

This diagnosis is based on the following findings:
  • Abused alcohol in the past 5 years (still present)
  • Greater use of alcohol than intended (still present)
  • There is a persistent desire or unsuccessful efforts to cut down or control alcohol use (still present)
  • A great deal of time is spent in obtaining alcohol, using alcohol, or recovering from its effects (still present)
  • Craving, or a strong desire or urge to use alcohol (still present)
  • Recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school or home (still present)
  • Continued alcohol use despite having persistent social problems that alcohol made worse (still present)
  • Important social, occupational, or recreational activities are given up or reduced because of alcohol use (still present)
  • Recurrent alcohol use in situations in which it is physically hazardous (still present)
  • Continued using alcohol despite knowing it caused significant problems (still present)
  • Developed tolerance to alcohol (still present)
  • Developed withdrawal symptoms to alcohol (still present)

Treatment Goals:

  • Goal: stop alcohol use because using more than intended.
    If this problem worsens: Repeated alcohol intoxication could continue to cause harmful psychological consequences (e.g., inappropriate sexual or aggressive behavior, mood lability, impaired judgment, impaired social or occupational functioning).

  • Goal: stop alcohol use because it is getting out of control.

  • Goal: stop alcohol use in order to prevent wasting so much time using alcohol, or recovering from its use.

  • Goal: stop alcohol use in order to decrease craving for alcohol.

  • Goal: stop alcohol use so that she can better fulfill major role obligations at work, school or home.

  • Goal: stop alcohol use in order to improve the alcohol-related social problems.

  • Goal: stop alcohol use in order to increase time spent on important social, occupational, or recreational activities.

  • Goal: stop alcohol use in hazardous situations in order to prevent injury.

  • Goal: stop alcohol use in order to prevent further worsening of current alcohol-related physical or emotional problems.

  • Goal: stop alcohol use because tolerance to alcohol is developing.

  • Goal: stop alcohol use because alcohol withdrawal symptoms are developing.


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Dependence Syndrome Due To Alcohol F10.2 - ICD10 Description, World Health Organization
Repeated alcohol use that typically includes a strong desire to take alcohol, difficulties in controlling its use, persisting in its use despite harmful consequences, a higher priority given to alcohol use than to other activities and obligations, increased tolerance, and a physical withdrawal state.


Alcohol Use Disorder - Diagnostic Criteria, American Psychiatric Association

An individual diagnosed with Alcohol Use Disorder needs to meet all of the following criteria:

  • A problematic pattern of alcohol use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12-month period:

    • Alcohol is often taken in larger amounts or over a longer period than was intended.

    • There is a persistent desire or unsuccessful efforts to cut down or control alcohol use.

    • A great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects.

    • Craving, or a strong desire or urge to use alcohol.

    • Recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school, or home.

    • Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol.

    • Important social, occupational, or recreational activities are given up or reduced because of alcohol use.

    • Recurrent alcohol use in situations in which it is physically hazardous.

    • Alcohol use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol.

    • Tolerance, as defined by either of the following:

      • A need for markedly increased amounts of alcohol to achieve intoxication or desired effect.

      • A markedly diminished effect with continued use of the same amount of alcohol.

    • Withdrawal, as manifested by either of the following:

      • The characteristic withdrawal syndrome for alcohol:

        • Cessation of (or reduction in) alcohol use that has been heavy and prolonged.

        • Two (or more) of the following, developing within several hours to a few days after the cessation of (or reduction in) alcohol use:

          • Autonomic hyperactivity (e.g., sweating or pulse rate greater than 100 bpm).

          • Increased hand tremor.

          • Insomnia.

          • Nausea or vomiting.

          • Transient visual, tactile, or auditory hallucinations or illusions.

          • Psychomotor agitation.

          • Anxiety.

          • Generalized tonic-clonic seizures.

      • Alcohol (or closely related substance, such as a benzodiazepine) is taken to relieve or avoid withdrawal symptoms.

    • Specify if:

      • In early remission: After full criteria for Alcohol Use Disorder were previously met, none of the criteria for Alcohol Use Disorder have been met for at least 3 months but for less than 12 months (with the exception that the criterion, "Craving, or a strong desire or urge to use alcohol," may be met).

      • In sustained remission: After full criteria for Alcohol Use Disorder were previously met, none of the criteria for Alcohol Use Disorder have been met at any time during a period of 12 months or longer (with the exception that the criterion, "Craving, or a strong desire or urge to use alcohol," may be met).

    • Specify if:

      • In a controlled environment: This additional specifier is used if the individual is in an environment where access to alcohol is restricted.


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Diagnostic Features

Alcohol Use Disorder is a condition characterized by the harmful consequences of repeated alcohol use, a pattern of compulsive alcohol use, and (sometimes) physiological dependence on alcohol (i.e., tolerance and/or symptoms of withdrawal).

This disorder is only diagnosed when these behaviors become persistent and very disabling or distressing. There is often craving for alcohol that makes it difficult to think of anything else until drinking resumes.

Alcohol Intoxication causes significant psychological and social impairment (e.g., inappropriate sexual or aggressive behavior, mood lability, impaired judgment, impaired social or occupational functioning).

This intoxication has one or more of the following physical signs: slurred speech, incoordination, unsteady gait, nystagmus, impairment in attention or memory, stupor or coma.

Alcohol Intoxication is similar to Benzodiazepine or Barbiturate Intoxication.

Alcohol Makes Anxiety Better, Then Worse:
Many alcoholics state that they started drinking "to calm their nerves" and this led to their addiction as their anxiety got worse. This is actually a misinterpretation of what actually happened.

Alcohol initially reduces anxiety; only to increase it a few hours later. In the first hour or two after drinking, alcohol has a sedative, antianxiety effect. Thereafter, alcohol actually increases anxiety, and this prompts the individual to ingest more alcohol.

Thus the more the individual drinks alcohol to "decrease anxiety"; the more alcohol causes increased anxiety. This is why alcohol is a bad treatment for insomnia since it only sedates the person for a few hours; then alcohol increases anxiety and arousal, which wakes the person up. The longer the individual can stay "dry" off alcohol; the less problem they will have with anxiety and insomnia.

Alcohol Withdrawal only occurs after the cessation of (or reduction in) heavy and prolonged alcohol use. This withdrawal syndrome includes two or more of the following: autonomic hyperactivity (e.g., sweating or pulse rate greater than 100); increased hand tremor; insomnia; psychomotor agitation; anxiety; nausea or vomiting; and, rarely, grand mal seizures or transient visual, tactile, or auditory hallucinations or illusions.

This withdrawal syndrome can be relieved by administering alcohol or any other brain depressant. These withdrawal symptoms usually begin within 4-12 hours of abstinence, and peak on the second day of abstinence. The Alcohol Withdrawal improves markedly by the 4th or 5th day of abstinence; however, symptoms of anxiety, insomnia, and autonomic dysfunction may persist for up to 3-6 months at lower levels of intensity.

Complications

School and job performance may suffer either from hangovers or from actual intoxication on the job or at school; child care or household responsibilities may be neglected; and alcohol-related absences may occur from school or job.

The individual may use alcohol in physically hazardous circumstances (e.g., drunk driving or operating machinery while intoxicated). Legal difficulties may arise because of alcohol use (e.g., arrests for intoxicated behavior or for drunk driving).

Individuals with this disorder may continue to abuse alcohol despite the knowledge that continued drinking poses significant social or interpersonal problems for them (e.g., violent arguments with spouse while intoxicated, child abuse). Alcohol intoxication causes significant intellectual impairment (and stupid behavior).

Once a pattern of compulsive use develops, individuals with this disorder may devote substantial periods of time to obtaining and consuming alcoholic beverages. These individuals continue to use alcohol despite evidence of adverse psychological or physical consequences (e.g., depression, blackouts, liver disease, or other complications).

Individuals with this disorder are at increased risk for accidents, violence, and suicide. It is estimated that 1 in 5 intensive care unit admissions in some urban hospitals is related to alcohol and that 40% of people in U.S.A. experience an alcohol-related accident at some time in their lives, with alcohol accounting for up to 55% of fatal driving events.

More than one-half of all murderers and their victims are believed to have been intoxicated with alcohol at the time of the murder.

Severe alcohol intoxication also contributes to disinhibition and feelings of sadness and irritability, which contribute to suicide attempts and completed suicides.

Comorbidity

Individuals with Alcohol Use Disorder are at increased risk for Major Depressive Disorder, other Substance Use Disorders (e.g., drug addiction), Conduct Disorder in adolescents, Antisocial and Borderline Personality Disorders, Schizophrenia, and Bipolar Disorder.

Associated Laboratory Findings

Evidence of alcohol use can be obtained by smelling alcohol on the individual's breath, or having the individual undertake breath, blood, or urine toxicology tests.

The most direct test available to measure alcohol consumption is blood alcohol concentration, which can also be used to judge tolerance to alcohol.

An individual with a concentration of 100 mg of ethanol per deciliter of blood who does not show signs of intoxication can be presumed to have acquired tolerance to alcohol. At 200 mg/dL, most non-alcoholic individuals would demonstrate severe intoxication.

An elevation (> 30 units) of gamma-glutamyltransferase (GGT) is a sensitive laboratory test for heavy drinking. At least 70% of individuals with a high GGT level are persistent heavy drinkers (i.e., consuming 8 or more drinks daily on a regular basis).

Another sensitive test for heavy drinking is an elevation (> 20 units) in carbohydrate deficient transferrin (CDT).

Both GGT and CDT levels return toward normal within days to weeks of stopping drinking, thus are useful tests to monitor abstinence. The combination of GGT and CDT may have even higher levels of sensitivity and specificity in diagnosing heavy drinking than either test used alone.

Another useful laboratory test for heavy drinking is an elevated mean corpuscular volume (MCV). However, the MCV is a poor method of monitoring abstinence because it takes weeks to return to normal after the individual stops drinking.

Liver function tests (e.g., alanine aminotransferase [ALT] and alkaline phosphatase) can reveal liver injury that is caused by heavy drinking. High fat content in the blood also contributes to the development of fatty liver.

Prevalence

Alcohol use is highly prevalent in most Western countries. However, in most Asian cultures, the overall prevalence of alcohol-related disorders is low. In Muslim countries, the Islamic religion strictly prohibits alcohol (hence the prevalence of alcohol-related disorders is very low).

In America, the male:female ratio is 2.5:1 and the lifetime risk of Alcohol Use Disorder is approximately 15% in the general population. The 12-month prevalence of Alcohol Use Disorder in America is 4.6% among 12- to 17-year-olds and 8.5% among adults age 18 years and older.

The 12-month prevalence rate is highest among individuals 18- to 29-years-old (16.%) and lowest among individuals aged 65 years and older (1.5%). In America for adults, the prevalence rates are greater among Native Americans and Alaska Natives (12.1%) than among whites (8.9%), Hispanics (7.9%), African Americans (6.9%), and Asian American and Pacific Islanders (4.5%).

Course

Alcohol Use Disorder has a variable course that is frequently characterized by periods of remission and relapse. The first episode of alcohol intoxication is likely to occur in the mid-teens, with the age at onset of Alcohol Use Disorder peaking in the 18- to 29-years-olds. The large majority of those who develop Alcohol Use Disorder do so by their late 30s.

Outcome

Follow-up studies of the typical person with an Alcohol Use Disorder show a higher than 65% 1-year abstinence rate following treatment.

Even among less functional and homeless individuals with Alcohol Use Disorder who complete a treatment program, as many as 60% are abstinent at 3 months, and 45% at 1 year. Some individuals (perhaps 20% or more) with Alcohol Use Disorder achieve long-term sobriety even without treatment.

Medical Complications

Only 5% of individuals with Alcohol Use Disorder ever experience severe complications of withdrawal (e.g., delirium, grand mal seizures).

However, repeated intake of high doses of alcohol can affect nearly every organ system, especially the gastrointestinal tract, cardiovascular system, and the central and peripheral nervous system. Gastrointestinal effects include gastritis, stomach or duodenal ulcers, and, in about 15% of those who use alcohol heavily, liver cirrhosis and pancreatitis.

There is also an increased rate of cancer of the esophagus, stomach, and other parts of the gastrointestinal tract. One of the most common associated general medical conditions is low-grade hypertension. There is an elevated risk of heart disease.

Peripheral neuropathy may be evidenced by muscular weakness, paresthesias, and decreased peripheral sensation. Most persistent central nervous system effects include cognitive deficits, severe memory impairment, and degenerative changes in the cerebellum (leading to poor balance and coordination).

One devastating central nervous system effect is the relatively rare alcohol-induced persisting amnestic disorder (Wernicke-Korsakoff syndrome) in which there is a dramatic impairment in short-term memory.

Men may develop erectile dysfunction and decreased testosterone levels.

Repeated heavy drinking in women is associated with menstrual irregularities and, during pregnancy, with spontaneous abortion and fetal alcohol syndrome (leading to mentally retarded, hyperactive children).

Alcohol Use Disorder can suppress immune mechanisms and predispose individuals to infections (e.g., pneumonia) and increase the risk for cancer.

Patients frequently have very poor insight into their addiction (i.e., denial).

Familial Pattern

Alcohol Use Disorder often has a familial pattern, and it is estimated that 40%-60% of the variance of risk is explained by genetic influences.

The risk for alcohol use disorder is 3 to 4 times higher in close relatives of people with alcohol use disorder. Most studies have found a significantly higher risk for alcohol use disorder in the monozygotic twin than in the dizygotic twin of a person with alcohol use disorder.

Adoption studies have revealed a 3- to 4-fold increase in risk for alcohol use disorder in the children of individuals with alcohol use disorder when these children were adopted away at birth and raised by adoptive parents who did not have this disorder.

Effective Therapies

Alcoholism is usually a chronic, episodic disorder associated with periods of sobriety punctuated by episodes of drinking. Therapy aims at preventing or shortening these relapses.

The "Helping Patients Who Drink Too Much: A Clinician's Guide" is an excellent treatment resource for clinicians. The "Rethinking Drinking Booklet" is an excellent educational resource for the public.

Warning: Individuals with Alcohol Use Disorder usually "forget" to take their anti-alcohol medications. Thus earlier research showed these medications weren't that effective.

Later research has shown that compliance - hence effectiveness - is significantly improved when another person daily supervises the patient's pill swallowing. The month-long injection of naltrexone dramatically increases its effectiveness.



Only 3 medications have been proven successful in relapse prevention. Each of these medications functions very differently.

Naltrexone blocks the pleasurable effect of alcohol, thus prevents the return to heavy drinking if there is an alcoholic relapse. It can be given in daily oral form, or as a month-long injection.

Acamprosate decreases the alcohol withdrawal craving, anxiety and insomnia that persists for months after termination of drinking. Thus acamprosate decreases the number of alcoholic relapses.

Disulfiram, when taken with alcohol, causes a person to turn red and vomit. Thus disulfiram can be taken to prevent drinking, or to prove that a person isn't drinking.

Antianxiety medication should only be used during medically supervised initial detoxification.

Addiction counselling and regular attendance at Alcoholics Anonymous (self-help group) meetings significantly improves treatment outcome.

Although residential rehabilitation programs are the most expensive of all treatments for Alcohol Use Disorder; there are no randomized controlled clinical trials that have yet proven the superiority of residential treatment over non-residential, outpatient treatment.







Top 20 Most Harmful Drugs In Britain In 2008

Professor David Nutt published in the Lancet the following rating of Britain's most dangerous drugs. They are listed in descending order from the most harmful.

1. Heroin

Class A drug. Originally used as a painkiller and derived from the opium poppy. There were 897 deaths recorded from heroin and morphine use in 2008 in England and Wales, according to the Office of National Statistics (ONS). There were around 13,000 seizures, amounting to 1.6m tonnes of heroin.

2. Cocaine

Class A. Stimulant produced from the South American coca leaf. Accounted for 235 deaths -- a sharp rise on the previous year's fatalities. Nearly 25,000 seizures were made, amounting to 2.9 tonnes of the drug.

3. Barbiturates

Class B. Synthetic sedatives used for anaesthetic purposes. Blamed for 13 deaths.

4. Street methadone

Class A. A synthetic opioid, commonly used as a substitute for treating heroin patients. Accounted for 378 deaths and there were more than 1,000 seizures of the drug.

5. Alcohol

Subject to increasing concern from the medical profession about its damage to health. According to the ONS, there were 8,724 alcohol deaths in the UK in 2007. Other sources claim the true figure is far higher.

6. Ketamine

Class C. A hallucinogenic dance drug for clubbers. There were 23 ketamine-related deaths in the UK between 1993 and 2006. Last year there were 1,266 seizures.

7. Benzodiazepines

Class C. A hypnotic relaxant used to treat anxiety and insomnia. Includes drugs such as diazepam, temazepam and nitrazepam. Caused 230 deaths and 1.8m doses were confiscated in more than 4,000 seizure operations.

8. Amphetamine

Class B. A psychostimulant that combats fatigue and suppresses hunger. Associated with 99 deaths, although this tally includes some ecstasy deaths. Nearly 8,000 seizures, adding up to almost three tonnes of confiscated amphetamines.

9. Tobacco

A stimulant that is highly addictive due to its nicotine content. More than 100,000 people a year die from smoking and tobacco-related diseases, including cancer, respiratory diseases and heart disease.

10. Buprenorphine

An opiate used for pain control, and sometimes as a substitute to wean addicts off heroin. Said to have caused 43 deaths in the UK between 1980 and 2002.

11. Cannabis

Class B. A psychoactive drug recently appearing in stronger forms such as "skunk". [Since this video was made; there is now conclusive proof that cannabis causes a 6.7 fold increase in the risk of developing schizophrenia.] Caused 19 deaths and there were 186,000 seizures, netting 65 tonnes of the drug and 640,000 cannabis plants.

12. Solvents

Fumes inhaled to produce a sense of intoxication. Usually abused by teenagers. Derived from commonly available products such as glue and aerosol sprays. Causes around 50 deaths a year.

13. 4-MTA

Class A. Originally designed for laboratory research. Releases serotonin in the body. Only four deaths reported in the UK between 1997 and 2004.

14. LSD

Class A. Hallucinogenic drug originally synthesised by a German chemist in 1938. Very few deaths recorded.

15. Methylphenidate

Class B drug. Brand name of Ritalin. A psychostimulant sometimes used in the treatment of attention deficit disorders.

16. Anabolic steroids

Class C. Used to develop muscles, notably in competitive sports. Also alleged to induce aggression. Have been blamed for causing deaths among bodybuilders. More than 800 seizures.

17. GHB

Class C drug. A clear liquid dance drug said to induce euphoria, also described as a date rape drug. Can trigger comas and suppress breathing. Caused 20 deaths and 47 seizures were recorded.

18. Ecstasy

Class A. Psychoactive dance drug. Caused 44 deaths, with around 5,000 seizures made.

19. Alykl nitrites

Known as "poppers". Inhaled for their role as a muscle relaxant and supposed sexual stimulant. Reduce blood pressure, which can cause fainting and in some cases death.

20. Khat

A psychoactive plant, the leaves of which are chewed in east Africa and Yemen. Also known as qat. Produces mild psychological dependence. Its derivatives, cathinone and cathine, are Class C drugs in the UK.

Ineffective therapies

Vitamins and dietary supplements are ineffective for preventing alcohol abuse.

Should Illicit Drugs Be Legalized?

The leading causes of death in USA in 2000 were tobacco (435 000 deaths; 18.1% of total US deaths), poor diet and physical inactivity (365 000 deaths; 15.2%), and alcohol consumption (85 000 deaths; 3.5%).

Some people argue that illicit drugs should be legalized to decrease the crime associated with these drugs. Historically, tobacco and alcohol were once illegal drugs. Tobacco smoking is now the leading cause of death in America, and alcoholism is the third leading cause of death.

Thus legalizing illicit drugs does not make them any less medically and socially harmful. In fact the opposite is true; legalizing illicit drugs increases their use and the harm they cause. The Government of Finland is passing legislation that will gradually ban all tobacco use by 2040.


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Dr. Gardere: Addiction


Dr. Willenbring: Treatment of Alcoholism



Experiment showing effects of alcohol drinking (to test poor reliability of breathalyzer)



Fetal Alcohol Spectrum Disorder







Scotland Has Reduced Alcoholism By Increasing The Cost Of Alcohol



Moderate drinking was supposedly good for you — until researchers added in the influence of wealth




Stories

Rating Scales

Alcoholics Anonymous

Stages of Learned Behavior

Our survival involves learning what to avoid (i.e., fear) and what to approach (i.e., crave). Both fear and craving are essential for our survival, but both can spiral out of control.

For example, an individual can develop a phobia about snakes in which the fear becomes excessive. This phobia can develop into an obsession in which the individual spends much of the time thinking about snakes, and how to avoid them.

This obsession can develop into a compulsion in which the individual spends much of the time doing superstitious, compulsive, ritual behaviors aimed at avoiding snakes.

Likewise, an individual can develop an excessive craving for alcohol which causes significant distress or disability.

This excessive craving for alcohol can develop into an obsession in which the individual spends much of the time thinking about alcohol, and how to get it.

This obsession can develop into a compulsion in which the individual spends much of the time compulsively drinking, and feeling powerless to resist this craving.

Four Stages of Fear and Craving

4 STAGES OF FEAR 4 STAGES OF CRAVING
Normal Fear:
Is in proportion to the actual danger, and doesn't cause significant distress or disability.
Normal Craving:
Doesn't cause significant distress or disability.
Excessive Fear (Phobia):
Is out of proportion to the actual danger posed, and causes significant distress or disability.
Excessive Craving:
Is not socially acceptable, and causes significant distress or disability (e.g., "I'm drinking too much").
Obsessional Fear:
Persistent, unwanted or obsessional thoughts about the fear develop, which cause significant distress or disability.
Obsessional Craving:
Persistent, unwanted or obsessional thoughts about the craving develop, which cause significant distress or disability (e.g., "I spend much of my time thinking about alcohol, and how to get it").
Compulsive Fear:
Compulsive behaviors develop (aimed at reducing the anxiety associated with the obsession), which the individual finds very hard to resist doing.
Compulsive Craving:
Compulsive behaviors develop (aimed at satisfying the craving), which the individual finds very hard to resist doing (e.g., "I can't stop myself from drinking").

Which Behavioral Dimensions Are Involved?

Research has shown that there are 5 major dimensions (the "Big 5 Factors") of personality disorders and other mental disorders. There are two free online personality tests that assess your personality in terms of the "Big 5 dimensions of personality". Although not computerized online, the Big Five Inventory (BFI) is a 44-item test often used in personality research.

This website uses these 5 major dimensions of human behavior to describe all mental disorders. (This website adds one more dimension, "Physical Health", but our discussion will focus on the first 5 major dimensions.)

These major dimensions of human behavior seem to represent the major dimensions whereby our early evolutionary ancestors chose their hunting companions or spouse. To maximize their chance for survival, our ancestors wanted companions who were agreeable, conscientious, intelligent, sociable, emotionally stable, and physically healthy.

    Which Dimensions of Human Behavior are Impaired in Alcohol Use Disorder?

    THE POSITIVE SIDE OF THE "BIG 5" PERSONALITY DIMENSIONS THE NEGATIVE SIDE OF THE "BIG 5" PERSONALITY DIMENSIONS DESCRIPTION (Where red = this disorder)
    Agreeableness Antagonism       Antagonism
    Conscientiousness Disinhibition       Disinhibition
    Openness/Intellect Low Openness/Intellect       Low Openness/Intellect (Cognitively Impaired)
    Sociability (Extraversion) Detachment       Sociability (Extraversion)
    Emotional Stability Negative Emotion       Emotional Stability


The 5 Major Dimensions of Mental Illness

The Big 5 Factors or dimensions of mental illness each has a healthy side and an unhealthy side. Thus the Big 5 Factors are: (1) Agreeableness vs. Antagonism, (2) Conscientiousness vs. Disinhibition, (3) Openness/Intellect vs. Low Openness/Intellect, (4) Sociability (Extraversion) vs. Detachment (Introversion), and (5) Emotional Stability vs. Negative Emotion.



The Following Pictures Are From The 2/6/2018 SpaceX Falcon Heavy Launch

AGREEABLENESS VS. ANTAGONISM
.
Agreeableness (Agreeable)
.
Description: Agreeableness is synonymous with compassion and politeness. Compassion reflects empathy, sympathy, and caring for others. Politeness reflects respect for others. Agreeable people are interested in others, and they make people feel comfortable. The Agreeableness dimension measures the behaviors that are central to the concept of JUSTICE (fair, honest, and helpful behavior - living in harmony with others, neither harming nor allowing harm). (This dimension appears to measure the behaviors that differentiate friend from foe.)
Descriptors: Compassionate, polite, warm, friendly, helpful, unselfish, generous, modest.
Language Characteristics: Pleasure talk, agreement, compliments, empathy, few personal attacks, few commands or global rejections, many self-references, few negations, few swear words, few threats, many insight words.
Research: Higher scores on Agreeableness are associated with deeper relationships. *MRI research found that Agreeableness was associated with increased volume in regions that process information about the intentions and mental states of other individuals.
"I am helpful and unselfish with others."
"I have a forgiving nature."
"I am generally trusting."
"I am considerate and kind to almost everyone."
"I like to cooperate with others."
"I don't find fault with others."
"I don't start quarrels with others."
"I am not cold and aloof."
"I am not rude to others."
"I feel other's emotions."
"I inquire about others' well-being."
"I sympathize with others' feelings."
"I take an interest in other people's lives."
"I like to do things for others."
"I respect authority."
"I hate to seem pushy."
"I avoid imposing my will on others."
"I rarely put people under pressure."
.
Antagonism (Antagonistic)
.
Description: Antagonism is synonymous with competition and aggression. Antagonistic people are self-interested, and do not see others positively.
Descriptors: Manipulative, deceitful, grandiose, callous, disrespectful, unfriendly, suspicious, uncooperative, malicious.
Language Characteristics: Problem talk, dissatisfaction, little empathy, many personal attacks, many commands or global rejections, few self-references, many negations, many swear words, many threats, little politeness, few insight words.
.
* Callousness:
"It's no big deal if I hurt other people's feelings."
"Being rude and unfriendly is just a part of who I am."
"I often get into physical fights."
"I enjoy making people in control look stupid."
"I am not interested in other people's problems."
"I can't be bothered with other's needs."
"I am indifferent to the feelings of others."
"I don't have a soft side."
"I take no time for others."
.
* Deceitfulness:
"I don't hesitate to cheat if it gets me ahead."
"Lying comes easily to me."
"I use people to get what I want."
"People don't realize that I'm flattering them to get something."
.
* Manipulativeness:
"I use people to get what I want."
"It is easy for me to take advantage of others."
"I'm good at conning people."
"I am out for my own personal gain."
.
* Grandiosity:
"I'm better than almost everyone else."
"I often have to deal with people who are less important than me."
"To be honest, I'm just more important than other people."
"I deserve special treatment."
.
* Suspiciousness:
"It seems like I'm always getting a “raw deal” from others."
"I suspect that even my so-called 'friends' betray me a lot."
"Others would take advantage of me if they could."
"Plenty of people are out to get me."
"I'm always on my guard for someone trying to trick or harm me."
.
* Hostility:
"I am easily angered."
"I get irritated easily by all sorts of things."
"I am usually pretty hostile."
"I always make sure I get back at people who wrong me."
"I resent being told what to do, even by people in charge."
"I insult people."
"I seek conflict."
"I love a good fight."
.
("Agreeableness vs. Antagonism" modified from "PID-5" by Kreuger RF, Derringer J, Markon KE, Watson D, Skodol AE and Between facets and domains: 10 aspects of the Big Five)
*MRI Research: Testing predictions from personality neuroscience. Brain structure and the big five.




CONSCIENTIOUSNESS VS. DISINHIBITION
.
Conscientiousness (Conscientious)
.
Description: Conscientiousness is synonymous with being self-disciplined, industrious and orderly. The Conscientiousness dimension measures the behaviors that are central to the concept of SELF-CONTROL - organizing and controlling one's behavior in order to achieve one's goals. (This dimension appears to measure the behaviors that differentiate behavioral order and inhibition from chaos and disinhibition.)
Descriptors: Industrious, self-disciplined, rule-abiding, organized
Language Characteristics: Many positive emotion words (e.g. happy, good), few negative emotion words (e.g. hate, bad), more perspective, careful to check that information is conveyed correctly, straight to the point, formal, few negations, few swear words, few references to friends, few disfluencies or filler words, many insight words, not impulsive.
Research: Higher scores on Conscientiousness predict greater success in school and at work. *MRI research found that Conscientiousness was associated with increased volume in the lateral prefrontal cortex, a region involved in planning and the voluntary control of behavior.
"I do a thorough job. I want everything to be 'just right'. I want every detail taken care of."
"I am careful."
"I am a reliable hard-worker."
"I am organized. I follow a schedule and always know what I am doing."
"I like order. I keep things tidy."
"I see that rules are observed."
"I do things efficiently. I get things done quickly."
"I carry out my plans and finish what I start."
"I am not easily distracted."
.
Rigid Perfectionism (Excessive Conscientiousness)
.
"Even though it drives other people crazy, I insist on absolute perfection in everything I do."
"I simply won't put up with things being out of their proper places."
"People complain about my need to have everything all arranged."
"People tell me that I focus too much on minor details."
"I have a strict way of doing things."
"I postpone decisions."
.
Disinhibition (Disinhibited)
.
Description: Disinhibition is synonymous with being distractible, impulsive and disorganized.
Descriptors: Distractible, impulsive, irresponsible, disorganised, unreliable, careless, forgetful
Language Characteristics: Few positive emotion words, many negative emotion words, less perspective, less careful, more vague, informal, many negations, many swear words, many references to friends (e.g. pal, buddy), many disfluencies or filler words, few insight words, impulsive.
.
* Irresponsibility:
"I've skipped town to avoid responsibilities."
"I just skip appointments or meetings if I'm not in the mood."
"I'm often pretty careless with my own and others' things."
"Others see me as irresponsible."
"I make promises that I don't really intend to keep."
"I often forget to pay my bills."
.
* Impulsivity:
"I usually do things on impulse without thinking about what might happen as a result."
"Even though I know better, I can't stop making rash decisions."
"I feel like I act totally on impulse."
"I'm not good at planning ahead."
.
* Distractibility:
"I can't focus on things for very long."
"I am easily distracted."
"I have trouble pursuing specific goals even for short periods of time."
"I can't achieve goals because other things capture my attention."
"I often make mistakes because I don't pay close attention."
"I waste my time ."
"I find it difficult to get down to work."
"I mess things up."
"I don't put my mind on the task at hand."
.
* Reckless Risk Taking:
"I like to take risks."
"I have no limits when it comes to doing dangerous things."
"People would describe me as reckless."
"I don't think about getting hurt when I'm doing things that might be dangerous."
.
* Hyperactivity:
"I move excessively (e.g., can't sit still; restless; always on the go)."
"I'm starting lots more projects than usual or doing more risky things than usual."
.
* Over-Talkativeness:
"I talk excessively (e.g., I butt into conversations; I complete people's sentences)."
"Often I talk constantly and cannot be interrupted."
.
* Elation:
"I feel much more happy, cheerful, or self-confident than usual."
"I'm sleeping a lot less than usual, but I still have a lot of energy."
.
("Conscientiousness vs. Disinhibition" modified from "PID-5" by Kreuger RF, Derringer J, Markon KE, Watson D, Skodol AE and Between facets and domains: 10 aspects of the Big Five)
*MRI Research: Testing predictions from personality neuroscience. Brain structure and the big five.




OPENNESS/INTELLECT vs. LOW OPENNESS/INTELLECT
.
Openness/Intellect (Open-Minded)
.
Description: Openness/Intellect (or "Openness To Experience") is synonymous with being open-minded and creative. The Openness/Intellect dimension measures the behaviors that are central to the concept of WISDOM - having experience, knowledge, and good judgment. (This dimension appears to measure the behaviors that differentiate open-minded from close-minded individuals.) Open-minded people are usually creative, sophisticated, intellectual, curious and interested in art.
Descriptors: Receptive to new ideas, curious, imaginative, creative, unconventional
Language Characteristics: Many positive emotion words (e.g. happy, good), high meaning elaboration, more perspective, politeness, few self-references, complex sentence constructions, few causation words, many inclusive words (e.g. with, and), few third person pronouns, many tentative words (e.g. maybe, guess), many insight words (e.g. think, see), few filler words and within-utterance pauses, stronger uncommon verbs.
Research: Higher scores on Openness/Intellect are associated with greater creativity and general intelligence. *MRI research found that Openness/Intellect did not have any significant correlation with the volume of any localized brain structure.
Relationship To General Intelligence: Research has shown that Openness/Intellect can be separated into 2 factors: Openness and Intellect. Intellect was independently associated with general intelligence (g) and with verbal and nonverbal intelligence about equally. Openness was independently associated only with verbal intelligence.
Example: This video shows how we see what we want to see. What we pay attention to (or what we believe about the world) blinds us to reality. (Exit YouTube after first video.)
"I am original, and come up with new ideas."
"I am curious about many different things."
"I am quick to understand things."
"I can handle a lot of information."
"I like to solve complex problems."
"I have a rich vocabulary."
"I think quickly and formulate ideas clearly."
"I enjoy the beauty of nature."
"I believe in the importance of art."
"I love to reflect on things."
"I get deeply immersed in music."
"I see beauty in things that others might not notice."
"I need a creative outlet."
.
Closed To Experience (Low Openness/Intellect)
.
Description: Low Openness/Intellect (or "Closed To Experience") is synonymous with being closed-minded and uncreative. Low Openness/Intellect is associated with narrow-mindedness, unimaginativeness and ignorance.
Descriptors: Narrow-minded, conservative, ignorant, simple
Language Characteristics: Few positive emotion words, low meaning elaboration, less perspective, less politeness, few positive emotion words, many self-references, simple sentence construction, many causation words (e.g. because, hence), many third person pronouns, few tentative words, few insight words, many filler words and within-utterance pauses, milder verbs.
.
"I prefer work that is routine."
"I have difficulty understanding abstract ideas."
"I think slowly."
"People find it hard to follow my logic or understand my thoughts."
"I avoid philosophical discussions."
"I avoid difficult reading material."
"People find it hard to follow my logic or understand my thoughts."
"I have few artistic interests."
"I seldom notice the emotional aspects of paintings and pictures."
"I do not like poetry."
"I seldom get lost in thought."
"I seldom daydream."
.
Cognitive Impairment
.
* Memory Impairment:
"I have difficulty learning new things, or remembering things that happened a few days ago."
"I often forget a conversation I had the day before."
"I often forget to take my medications, or to keep my appointments."
.
* Impaired Reasoning:
"My judgment or ability to solve problems isn't good."
"I have difficulty understanding abstract ideas."
"I think slowly."
"People find it hard to follow my logic or understand my thoughts."
.
Psychoticism
.
Description: Psychoticism is the state of being psychotic or of being predisposed to develop psychosis.
Descriptors: Unusual beliefs and experiences, eccentricity, perceptual dysregulation.
.
* Eccentricity:
"I often have thoughts that make sense to me but that other people say are strange."
"Others seem to think I'm quite odd or unusual."
"My thoughts are strange and unpredictable."
"My thoughts often don’t make sense to others."
"Other people seem to think my behavior is weird."
"I have several habits that others find eccentric or strange."
"My thoughts often go off in odd or unusual directions."
.
* Unusual Beliefs and Experiences:
"I often have unusual experiences, such as sensing the presence of someone who isn't actually there."
"I've had some really weird experiences that are very difficult to explain."
"I have seen things that weren’t really there."
"I have some unusual abilities, like sometimes knowing exactly what someone is thinking."
"I sometimes have heard things that others couldn’t hear."
"Sometimes I can influence other people just by sending my thoughts to them."
"I often see unusual connections between things that most people miss."
.
* Perceptual Dysregulation:
"Things around me often feel unreal, or more real than usual."
"Sometimes I get this weird feeling that parts of my body feel like they're dead or not really me."
"It's weird, but sometimes ordinary objects seem to be a different shape than usual."
"Sometimes I feel 'controlled' by thoughts that belong to someone else."
"Sometimes I think someone else is removing thoughts from my head."
"I have periods in which I feel disconnected from the world or from myself."
"I can have trouble telling the difference between dreams and waking life."
"I often 'zone out' and then suddenly come to and realize that a lot of time has passed."
"Sometimes when I look at a familiar object, it's somehow like I'm seeing it for the first time."
"People often talk about me doing things I don't remember at all."
"I often can't control what I think about."
"I often see vivid dream-like images when I’m falling asleep or waking up."
.
("OPENNESS TO EXPERIENCE vs. BEING CLOSED TO EXPERIENCE" modified from "PID-5" by Kreuger RF, Derringer J, Markon KE, Watson D, Skodol AE and Between facets and domains: 10 aspects of the Big Five)
*MRI Research: Testing predictions from personality neuroscience. Brain structure and the big five.




SOCIABILITY (EXTRAVERSION) vs. DETACHMENT
.
Sociability (Sociable)
.
Description: Sociability (Extraversion) is synonymous with being enthusiastic and assertive. Assertiveness encompasses traits relating to leadership, dominance, and drive. Enthusiasm encompasses both outgoing friendliness or sociability and the tendency to experience and express positive emotion. Extraverts tend to engage in social interaction; they are enthusiastic, risk-taking, talkative and assertive. The Extraversion dimension measures the behaviors that are central to the concept of SOCIABILITY - seeking and enjoying companionship. (This dimension appears to measure the behaviors that differentiate approach from avoidance.)
Descriptors: Sociable, gregarious, reward-seeking, talkative.
Language Characteristics: Many topics, higher verbal output, think out loud, pleasure talk, agreement, compliment, positive emotion words, sympathetic, concerned about hearer (but not empathetic), simple constructions, few unfilled pauses, few negations, few tentative words, informal language, many swear words, exaggeration (e.g. really), many words related to humans (e.g. man, pal), poor vocabulary.
Research: Higher scores on Sociability (extraversion) are associated with greater happiness and broader social connections. *MRI research found that Sociability (extraversion) was associated with increased volume of medial orbitofrontal cortex, a region involved in processing reward information.
"I'm talkative"
"I'm not reserved."
"I'm full of energy."
"I generate a lot of enthusiasm."
"I'm not quiet."
"I have an assertive personality."
"I'm not shy or inhibited."
"I am outgoing and sociable."
"I make friends easily."
"I warm up quickly to others."
"I show my feelings when I'm happy."
"I have a lot of fun."
"I laugh a lot."
"I take charge."
"I have a strong personality."
"I know how to captivate people."
"I see myself as a good leader."
"I can talk others into doing things."
"I am the first to act."
.
Attention Seeking (Excessive Sociability)
.
"I like to draw attention to myself."
"I crave attention."
"I do things to make sure people notice me."
"I do things so that people just have to admire me."
"My behavior is often bold and grabs peoples' attention."
.
Detachment (Detached)
.
Description: Detachment is synonymous with being reserved and quiet.
Descriptors: Withdrawn, anhedonic (pleasureless), intimacy avoiding, Detached, shy, passive, solitary, moody
Language Characteristics: Single topic, doesn't think out loud, problem talk, dissatisfaction, negative emotion words, not sympathetic, elaborated sentence constructions, many unfilled pauses, formal language, many negations, many tentative words (e.g. maybe, guess), few swear words, little exaggeration, few words related to humans, rich vocabulary.
.
* Social Withdrawal:
"I don’t like to get too close to people."
"I don't deal with people unless I have to."
"I'm not interested in making friends."
"I don’t like spending time with others."
"I say as little as possible when dealing with people."
"I keep to myself."
"I am hard to get to know."
"I reveal little about myself."
"I do not have an assertive personality."
"I lack the talent for influencing people."
"I wait for others to lead the way."
"I hold back my opinions."
.
* Intimacy Avoidance:
"I steer clear of romantic relationships."
"I prefer to keep romance out of my life."
"I prefer being alone to having a close romantic partner."
"I'm just not very interested in having sexual relationships."
"II break off relationships if they start to get close."
.
* Anhedonia (Lack of Pleasure):
"I often feel like nothing I do really matters."
"I almost never enjoy life."
"Nothing seems to make me feel good."
"Nothing seems to interest me very much."
"I almost never feel happy about my day-to-day activities."
"I rarely get enthusiastic about anything."
"I don't get as much pleasure out of things as others seem to."
.
* Restricted Emotions:
"I don't show emotions strongly."
"I don't get emotional."
"I never show emotions to others."
"I don't have very long-lasting emotional reactions to things."
"People tell me it's difficult to know what I'm feeling."
"I am not a very enthusiastic person."
.
("Sociability vs. Detachment" modified from "PID-5" by Kreuger RF, Derringer J, Markon KE, Watson D, Skodol AE and Between facets and domains: 10 aspects of the Big Five)
*MRI Research: Testing predictions from personality neuroscience. Brain structure and the big five.




EMOTIONAL STABILITY VS. NEGATIVE EMOTION
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Emotional Stability (Emotionally Stable)
.
Description: Emotional Stability is synonymous with being calm and emotionally stable. The Emotional Stability dimension measures the behaviors that are central to the concept of COURAGE - having calm composure and endurance when confronting adversity. (This dimension appears to measure the behaviors that differentiate safety from danger.)
Descriptors: Calm, even-tempered, peaceful, confident
Language Characteristics: Pleasure talk, agreement, compliment, low verbal productivity, few repetitions, neutral content, calm, few self-references, many short silent pauses, few long silent pauses, many tentative words, few aquiescence, little exaggeration, less frustration, low concreteness.
"I am relaxed, and I handle stress well."
"I am emotionally stable, and not easily upset."
"I remain calm in tense situations."
"I rarely get irritated."
"I keep my emotions under control."
"I rarely lose my composure."
"I am not easily annoyed."
"I seldom feel blue."
"I feel comfortable with myself."
"I rarely feel depressed."
"I am not embarrassed easily."
.
Negative Emotion (Negative Emotions)
.
Description: Degree to which people experience persistent anxiety or depression and are easily upset. (This could be thought of as high threat sensitivity or low stress tolerance.)
Descriptors: Emotionally unstable, anxious, separation-insecure, depressed, self-conscious, oversensitive, vulnerable.
Language Characteristics: Problem talk, dissatisfaction, high verbal productivity, many repetitions, polarised content, stressed, many self-references, few short silent pauses, many long silent pauses, few tentative words, more aquiescence, many self references, exaggeration, frustration, high concreteness.
Research: Lower scores on Emotional Stability are associated with unhappiness, dysfunctional relationships, and mental health problems. *MRI research found that Low Emotional Stability (= Negative Emotion or Neuroticism) was associated with increased volume of brain regions associated with threat, punishment, and negative emotions.
.
* Emotional Instability:
"I get emotional easily, often for very little reason."
"I get emotional over every little thing."
"My emotions are unpredictable."
"I never know where my emotions will go from moment to moment."
"I am a highly emotional person."
"I have much stronger emotional reactions than almost everyone else."
"My emotions sometimes change for no good reason."
"I get angry easily."
"I get upset easily."
"I change my mood a lot."
"I am a person whose moods go up and down easily."
"I get easily agitated."
"I can be stirred up easily."
.
* Anxiety:
"I worry about almost everything."
"I'm always fearful or on edge about bad things that might happen."
"I always expect the worst to happen."
"I am a very anxious person."
"I get very nervous when I think about the future."
"I often worry that something bad will happen due to mistakes I made in the past."
"I am filled with doubts about things."
"I feel threatened easily."
"I am afraid of many things."
.
* Separation Insecurity:
"I fear being alone in life more than anything else."
"I can't stand being left alone, even for a few hours."
"I’d rather be in a bad relationship than be alone."
"I'll do just about anything to keep someone from abandoning me."
"I dread being without someone to love me."
.
* Submissiveness:
"I usually do what others think I should do."
"I do what other people tell me to do."
"I change what I do depending on what others want."
.
* Perseveration:
"I get stuck on one way of doing things, even when it's clear it won't work."
"I get stuck on things a lot."
"It is hard for me to shift from one activity to another."
"I get fixated on certain things and can’t stop."
"I feel compelled to go on with things even when it makes little sense to do so."
"I keep approaching things the same way, even when it isn’t working."
.
* Depressed Mood:
"I have no worth as a person."
"Everything seems pointless to me."
"I often feel like a failure."
"The world would be better off if I were dead."
"The future looks really hopeless to me."
"I often feel just miserable."
"I'm very dissatisfied with myself."
"I often feel like nothing I do really matters."
"I know I'll commit suicide sooner or later."
"I talk about suicide a lot."
"I feel guilty much of the time."
"I'm so ashamed by how I've let people down in lots of little ways."
"I am easily discouraged."
"I become overwhelmed by events."
.
("Emotional Stability vs. Negative Emotion" modified from "PID-5" by Kreuger RF, Derringer J, Markon KE, Watson D, Skodol AE and Between facets and domains: 10 aspects of the Big Five)
*MRI Research: Testing predictions from personality neuroscience. Brain structure and the big five.


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World Health Organization Alcohol Use Disorder Treatment Guidelines

Drug Therapy For Alcoholism Doesn't Cure Alcoholism, But Often It Is The Only Thing That Stops Drinking

Alcoholism is usually a chronic, episodic disorder associated with periods of sobriety punctuated by episodes of drinking. Drug therapy aims at preventing or shortening these relapses. In this regard, drug therapy for alcoholism can be very successful.

However, there is a serious limitation to drug therapy for alcoholism. Usually another person must daily supervise the taking of these medications. Warning: Missing two consecutive days of these medications often results in a drinking relapse.

Secret drinking can be accurately detected with alcohol breathalyzers.

Many individuals are only convinced that they are alcoholics when they drink, turn bright red, and vomit while on disulfiram - despite knowing this would happen. Only then do they realize that they can't stop drinking. Thus disulfiram should be taken daily to prevent (or diagnose) alcoholic relapses.

Unfortunately, years of use of disulfiram in some people may cause a peripheral neuropathy (e.g., foot drop) which would necessitate its termination.

Only three medications - disulfiram, naltrexone, and acamprosate - are approved for the treatment of alcoholism by the U.S. Food and Drug Administration:

  • Disulfiram:
    When taken with alcohol, causes a person to turn bright red and vomit. Thus disulfiram can be taken to prevent drinking, or to prove that a person isn't drinking. Alcohol can not be taken 48 hours before or after the ingestion of disulfiram. Disulfiram can not be used in pregnancy.

  • Naltrexone:
    Blocks the pleasurable effect of alcohol, thus decreases the urge to drink. It can be given in daily oral form, or as a month-long injection. Naltrexone can be safely used in pregnancy. Naltrexone reduces relapse rates after abstinence and also helps reduce heavy drinking in people who continue drinking during treatment.

  • Acamprosate:
    When taken daily, decreases craving, anxiety and insomnia. Acamprosate can not be used in pregnancy.

Antianxiety medication should only be used during medically supervised initial detoxification.

Addiction counselling and regular attendance at Alcoholics Anonymous (self-help group) meetings significantly improves treatment outcome.

Although residential rehabilitation programs are the most expensive of all treatments for Alcohol Use Disorder; there are no randomized controlled clinical trials that have yet proven the superiority of residential treatment over non-residential, outpatient treatment.





APA Releases New Practice Guideline on Alcohol Use Disorder Pharmacotherapy (2018)

  • Alcohol Use Disorder Treatment Guidelines
  • "The Science and Treatment of Alcoholism" - omits mention of proven treatments for alcoholism (2015) This article (at Medscape.com) omits to mention the three medications - disulfiram, naltrexone, and acamprosate - that are approved for the treatment of alcoholism by the U.S. Food and Drug Administration. That is quite an omission.
  • Determining the relative importance of the mechanisms of behavior change within Alcoholics Anonymous: a multiple mediator analysis. (2012) Among out-patients the effect of AA attendance on alcohol outcomes was explained primarily by adaptive social network changes and increases in social abstinence self-efficacy. Among more impaired aftercare patients, in addition to mediation through adaptive network changes and increases in social self-efficacy, AA lead to better outcomes through increasing spirituality/religiosity and by reducing negative emotion. The degree to which mediators explained the relationship between AA and outcomes ranged from 43% to 67%.
  • Does sponsorship improve outcomes above Alcoholics Anonymous attendance? A latent class growth curve analysis. (2012) Any pattern of Alcoholics Anonymous attendance, even if it declines or is never high for a particular 12-month period, is better than little or no attendance in terms of abstinence. Greater initial attendance carries added value. There is a benefit for maintaining a sponsor over time above that found for attendance.
  • Do women differ from men on Alcoholics Anonymous participation and abstinence? A multi-wave analysis of treatment seekers. (2012) Women and men attended AA at similar rates and similarly practiced specific AA behaviors, and they were alike on most factors associated with AA participation and abstention across time including abstinence goal, drink volume, negative consequences, prior treatment, and encouragement to reduce drinking. Relative to men, women with higher drug severity were less likely to participate in AA. Although higher AA participation was a predictor of abstinence for both genders, men were less likely to be abstinent across time. Men were also more likely to reduce their AA participation across time.
  • Predictors of membership in Alcoholics Anonymous in a sample of Successfully remitted alcoholics. (2011) This study identifies factors associated with Alcoholics Anonymous (AA) membership in a sample of 81 persons who have achieved at least one year of total abstinence from alcohol and other drugs. Forty-four were AA members, 37 were not. Having more positive views of God and more negative consequences of drinking were significantly associated with AA membership. This information can be used by clinicians to identify clients for whom AA might be a good fit, and can help others overcome obstacles to AA or explore alternative forms of abstinence support.
  • Driving while intoxicated among individuals initially untreated for Alcohol Use Disorders: one- and sixteen-year follow-ups. (2011) More extended participation in outpatient treatment and Alcoholics Anonymous (AA) during Year 1 was associated with a lower likelihood of DWI at the 1-year follow-up. More extended participation in AA through Year 3 was associated with a lower likelihood of DWI at the 16-year follow-up. Improvement on personal functioning and life context indices was associated with reduced risk of subsequent occurrences of DWI.
  • How safe are adolescents at Alcoholics Anonymous and Narcotics Anonymous meetings? A prospective investigation with outpatient youth. (2011) Overall, youth reported feeling very safe at meetings, and ratings did not differ by age or gender. Reasons for discontinuation or nonattendance were unrelated to safety or negative incidents.
  • Meta-analysis of pharmacological therapy with acamprosate, naltrexone, and disulfiram--a systematic review. (2011) The meta-analysis is based on 16 randomized controlled trials of acamprosate, 18 of naltrexone and 7 of disulfiram. Acamprosate and naltrexone were 52% (RR = 1.52; 95% confidence interval (CI): 1.35-1,72) and 27% (RR = 1.27; 95% CI: 1,06-1,52) better than placebo when it came to supporting continuous abstinence. Acamprosate increased the total number of abstinence days by 14% (MD = 14.02; 95% CI: 9.57-18.47). Disulfiram appeared to be effective only when the intake was supervised. Based on the amount of scientific evidence, acamprosate and naltrexone therapy should be increased in clinical practice in the treatment of alcoholism.
  • Mindfulness based interventions for addictive disorders: a review. (2011) Results of six clinical trials evaluating four different programs were found. Five studies were controlled and four were randomized. Drop-out rates were relatively high (from 28 to 55%). In five cases out of six, the program significantly reduced substance use. In four comparative trials out of five, interventions based on mindfulness proved more effective than control conditions.
  • A literature review of cost-benefit analyses for the treatment of Alcohol Use Disorder. (2011) In the psychotherapy studies, major benefits are typically seen within the first six months of treatment. The benefit-cost ratio ranged from 1.89 to 39.0. Treatment with acamprosate was found to accrue a net benefit of 21,301 BEF (528 euros) per patient over a 24-month period in Belgium and lifetime benefit for each patient in Spain was estimated to be Pta. 3,914,680 (23,528 euros). To date, only a few studies exist that have examined the cost-benefit of psychotherapy or pharmacotherapy treatment of AD. Most of the available treatment options for AD appear to produce marked economic benefits.
  • Brief interventions for heavy alcohol users admitted to general hospital wards. (2011) Objective: To determine whether brief interventions reduce alcohol consumption and improve outcomes for heavy alcohol users admitted to general hospital inpatient units. Our results demonstrate that patients receiving brief interventions have a greater reduction in alcohol consumption compared to those in control groups at six month, MD -69.43 (95% CI -128.14 to -10.72) and nine months follow up, MD -182.88 (95% CI -360.00 to -5.76) but this is not maintained at one year. In addition there were significantly fewer deaths in the groups receiving brief interventions than in control groups at 6 months, RR 0.42 (95% CI 0.19 to 0.94) and one year follow up, RR 0.60 (95% CI 0.40 to 0.91). Furthermore screening, asking participants about their drinking patterns, may also have a positive impact on alcohol consumption levels and changes in drinking behavior.
  • How cognitive assessment through clinical neurophysiology may help optimize chronic alcoholism treatment. (2011) Although psychosocial treatments (e.g. individual or group therapy) have historically been the mainstay of alcoholism treatment, a successful approach for alcohol dependence consists in associating pharmacologic medications with therapy, as 40-70% of patients following only psychosocial therapy typically resume alcohol use within a year of post-detoxification treatment. Nowadays, two main pharmacological options, naltrexone and acomprosate, both approved by the US Food and Drug Administration, are available and seemingly improve on the results yielded by standard techniques employed in the management of alcoholism. However, insufficient data exist to confirm the superiority of one drug over the other.
  • The efficacy of disulfiram for the treatment of Alcohol Use Disorder. (2011) Supervised treatment with disulfiram has some effect on short-term abstinence and days until relapse as well as number of drinking days when compared with placebo, none, or other treatments for patients with alcohol dependency or abuse. Long-term effect on abstinence has not been evaluated yet. However, there is a need for more homogeneous and high-quality studies in the future regarding the efficacy of disulfiram.
  • A systematic review and meta-analysis of health care utilization outcomes in alcohol screening and brief intervention trials. (2011) Systematic review results suggest that alcohol screening and brief intervention has little to no effect on inpatient or outpatient health care utilization, but it may have a small, negative effect on ED utilization.
  • Medical treatment of alcohol dependence: a systematic review. (2011) The evidence base for oral naltrexone (6% more days abstinent than placebo in the largest study) and topiramate (prescribed off-label) (e.g., 26.2% more days abstinent than placebo in a recent study) is positive but modest. Acamprosate shows modest efficacy with recently abstinent patients, with European studies showing better results than U.S. ones. The evidence-base for disulfiram is equivocal. Depot naltrexone shows efficacy (25% greater reduction in rate of heavy drinking vs. placebo, in one of the largest studies) in a limited number of studies. Some studies suggest that patients do better with extensive psychosocial treatments added to medications while others show that brief support can be equally effective.
  • Does Teen Drug Rehab Cure Addiction or Create It? (2010)
  • Following problem drinkers over eleven years: understanding changes in alcohol consumption. (2010) Results suggest that problem and dependent drinkers continue to drink at an elevated level over the course of years. Gatekeepers, family members, and policymakers should encourage and facilitate contact with social service agencies and with AA for problem drinkers. Suggestions from others to do something about one's drinking and seeking specialty care occur more often in those with more severe problems and do not appear to be linked to less drinking over time.
  • Negative emotion, relapse, and Alcoholics Anonymous (AA): does AA work by reducing anger? (2010) Findings revealed substantially elevated levels of anger in those attending AA compared with the general population (98th percentile) that decreased over 15-month follow-up but remained high (89th percentile). AA attendance was associated with better drinking outcomes, and higher levels of anger were associated with heavier drinking. However, AA attendance was unrelated to changes in anger.
  • Mechanisms of behavior change in alcoholics anonymous: does Alcoholics Anonymous lead to better alcohol use outcomes by reducing depression symptoms? (2010) AA attendance was associated both concurrently and predictively with improved alcohol outcomes. Although AA attendance was associated additionally with subsequent improvements in depression, it did not predict such improvements over and above concurrent alcohol use. AA appears to lead both to improvements in alcohol use and psychological and emotional wellbeing which, in turn, may reinforce further abstinence and recovery-related change.
  • Opioid antagonists for alcohol dependence. (2010) Naltrexone reduced the risk of heavy drinking to 83% of the risk in the placebo group RR 0.83 (95% CI 0.76 to 0.90) and decreased drinking days by about 4%, MD -3.89 (95% CI -5.75 to -2.04). Naltrexone appears to be an effective and safe strategy in alcoholism treatment; even though the sizes of treatment effects might appear moderate in their magnitudes.
  • A comprehensive review: methodological rigor of studies on residential treatment centers for substance-abusing adolescents. (2009) Out of the four most rigorous studies reviewed, two found significant differences in substance use reduction between the treatment and comparison groups. Of the remaining studies, despite having strong selectivity bias, only one found significant differences between treatment and comparison groups, and it was for females only at the one-year follow-up.
  • Effectiveness and cost-effectiveness of policies and programmes to reduce the harm caused by alcohol. (2009) Systematic reviews and meta-analyses show that policies regulating the environment in which alcohol is marketed (particularly its price and availability) are effective in reducing alcohol-related harm. Enforced legislative measures to reduce drink-driving and individually directed interventions to already at-risk drinkers are also effective. However, school-based education does not reduce alcohol-related harm, although public information and education-type programmes have a role in providing information and in increasing attention and acceptance of alcohol on political and public agendas. Making alcohol more expensive and less available, and banning alcohol advertising, are highly cost-effective strategies to reduce harm.
  • Acupuncture for alcohol dependence: a systematic review. (2009) The poor methodological quality and the limited number of the trials do not allow any conclusion about the efficacy of acupuncture for treatment of alcohol dependence.
  • Epidemiology of alcoholics anonymous participation. (2008) Fully one-half of those completing AA's most recent membership survey reported that they had been abstinent for more than 5 years. Disengagement from AA does not appear to necessarily translate to loss of abstinence among those with initial high levels of AA exposure, but long-term abstinence is more likely among those with continued engagement.
  • The Surgeon General's Call to Action To Prevent and Reduce Underage Drinking (2007)

Treatment Evaluation

Crime




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Alcohol Abuse Treatment and Self-Help


Self-Help Groups for Alcohol Addiction


Improving Positive Behavior

Philosophers for the past 2,500 years have taught that it is very beneficial to start the day with goal-setting, and end the day with a brief review.

This habit of planning your day in the morning, and reviewing your day in the evening, is a time-proven technique for more successful living.

Note: When each of the following videos finishes; you must exit YouTube (by manually closing the window) in order to return to this webpage.



Morning Meditation (5-Minute Video)



Evening Meditation (5-Minute Video)



Life Satisfaction Scale (Video)



Healthy Social Behavior Scale (Video)



Mental Health Scale (Video)

Why We All Need to Practice Emotional First Aid



The Philosophy Of Stoicism (5 minute video)

Stoicism 101 (52 minute video)



The Roman emperor and Stoic philosopher Marcus Aurelius ruled from 161 to 180 A.D.

Inspirational Videos

  • His Holiness Pope Francis is one of the few world leaders that champions universal love, brotherhood, and peace (TED talk)

    Life Is About Interactions (His Holiness Pope Francis)

    Quite a few years of life have strengthened my conviction that each and everyone's existence is deeply tied to that of others: life is not time merely passing by, life is about interactions.

    As I meet, or lend an ear to those who are sick, to the migrants who face terrible hardships in search of a brighter future, to prison inmates who carry a hell of pain inside their hearts, and to those, many of them young, who cannot find a job, I often find myself wondering: "Why them and not me?" I, myself, was born in a family of migrants; my father, my grandparents, like many other Italians, left for Argentina and met the fate of those who are left with nothing. I could have very well ended up among today's "discarded" people. And that's why I always ask myself, deep in my heart: "Why them and not me?"

    First and foremost, I would love it if this meeting could help to remind us that we all need each other, none of us is an island, an autonomous and independent "I," separated from the other, and we can only build the future by standing together, including everyone. We don’t think about it often, but everything is connected, and we need to restore our connections to a healthy state. Even the harsh judgment I hold in my heart against my brother or my sister, the open wound that was never cured, the offense that was never forgiven, the rancor that is only going to hurt me, are all instances of a fight that I carry within me, a flare deep in my heart that needs to be extinguished before it goes up in flames, leaving only ashes behind.

    Many of us, nowadays, seem to believe that a happy future is something impossible to achieve. While such concerns must be taken very seriously, they are not invincible. They can be overcome when we don't lock our door to the outside world. Happiness can only be discovered as a gift of harmony between the whole and each single component. Even science – and you know it better than I do – points to an understanding of reality as a place where every element connects and interacts with everything else.

    Social Inclusion (Solidarity)

    And this brings me to my second message. How wonderful would it be if the growth of scientific and technological innovation would come along with more equality and social inclusion. How wonderful would it be, while we discover faraway planets, to rediscover the needs of the brothers and sisters orbiting around us. How wonderful would it be if solidarity, this beautiful and, at times, inconvenient word, were not simply reduced to social work, and became, instead, the default attitude in political, economic and scientific choices, as well as in the relationships among individuals, peoples and countries. Only by educating people to a true solidarity will we be able to overcome the "culture of waste," which doesn't concern only food and goods but, first and foremost, the people who are cast aside by our techno-economic systems which, without even realizing it, are now putting products at their core, instead of people.

    Solidarity is a term that many wish to erase from the dictionary. Solidarity, however, is not an automatic mechanism. It cannot be programmed or controlled. It is a free response born from the heart of each and everyone. Yes, a free response! When one realizes that life, even in the middle of so many contradictions, is a gift, that love is the source and the meaning of life, how can they withhold their urge to do good to another fellow being? In order to do good, we need memory, we need courage and we need creativity. Good intentions and conventional formulas, so often used to appease our conscience, are not enough. Let us help each other, all together, to remember that the other is not a statistic or a number. The other has a face. The "you" is always a real presence, a person to take care of.

    Compassion

    There is a parable Jesus told to help us understand the difference between those who'd rather not be bothered and those who take care of the other. I am sure you have heard it before. It is the Parable of the Good Samaritan. When Jesus was asked: "Who is my neighbor?" - namely, "Who should I take care of?" - he told this story, the story of a man who had been assaulted, robbed, beaten and abandoned along a dirt road. Upon seeing him, a priest and a Levite, two very influential people of the time, walked past him without stopping to help. After a while, a Samaritan, a very much despised ethnicity at the time, walked by. Seeing the injured man lying on the ground, he did not ignore him as if he weren't even there. Instead, he felt compassion for this man, which compelled him to act in a very concrete manner. He poured oil and wine on the wounds of the helpless man, brought him to a hostel and paid out of his pocket for him to be assisted.

    The story of the Good Samaritan is the story of today’s humanity. People's paths are riddled with suffering, as everything is centered around money, and things, instead of people. And often there is this habit, by people who call themselves "respectable," of not taking care of the others, thus leaving behind thousands of human beings, or entire populations, on the side of the road. Fortunately, there are also those who are creating a new world by taking care of the other, even out of their own pockets. Mother Teresa actually said: "One cannot love, unless it is at their own expense." We have so much to do, and we must do it together. But how can we do that with all the evil we breathe every day? Thank God, no system can nullify our desire to open up to the good, to compassion and to our capacity to react against evil, all of which stem from deep within our hearts. Now you might tell me, "Sure, these are beautiful words, but I am not the Good Samaritan, nor Mother Teresa of Calcutta." On the contrary: we are precious, each and every one of us. Each and every one of us is irreplaceable in the eyes of God. Through the darkness of today's conflicts, each and every one of us can become a bright candle, a reminder that light will overcome darkness, and never the other way around.

    Hope

    To Christians, the future does have a name, and its name is Hope. Feeling hopeful does not mean to be optimistically naïve and ignore the tragedy humanity is facing. Hope is the virtue of a heart that doesn't lock itself into darkness, that doesn't dwell on the past, does not simply get by in the present, but is able to see a tomorrow. Hope is the door that opens onto the future. Hope is a humble, hidden seed of life that, with time, will develop into a large tree. It is like some invisible yeast that allows the whole dough to grow, that brings flavor to all aspects of life. And it can do so much, because a tiny flicker of light that feeds on hope is enough to shatter the shield of darkness. A single individual is enough for hope to exist, and that individual can be you. And then there will be another "you," and another "you," and it turns into an "us." And so, does hope begin when we have an "us?" No. Hope began with one "you." When there is an "us," there begins a revolution.

    Tenderness

    The third message I would like to share today is, indeed, about revolution: the revolution of tenderness. And what is tenderness? It is the love that comes close and becomes real. It is a movement that starts from our heart and reaches the eyes, the ears and the hands. Tenderness means to use our eyes to see the other, our ears to hear the other, to listen to the children, the poor, those who are afraid of the future. To listen also to the silent cry of our common home, of our sick and polluted earth. Tenderness means to use our hands and our heart to comfort the other, to take care of those in need.

    Tenderness is the language of the young children, of those who need the other. A child’s love for mom and dad grows through their touch, their gaze, their voice, their tenderness. I like when I hear parents talk to their babies, adapting to the little child, sharing the same level of communication. This is tenderness: being on the same level as the other. God himself descended into Jesus to be on our level. This is the same path the Good Samaritan took. This is the path that Jesus himself took. He lowered himself, he lived his entire human existence practicing the real, concrete language of love. Yes, tenderness is the path of choice for the strongest, most courageous men and women. Tenderness is not weakness; it is fortitude. It is the path of solidarity, the path of humility. Please, allow me to say it loud and clear: the more powerful you are, the more your actions will have an impact on people, the more responsible you are to act humbly. If you don’t, your power will ruin you, and you will ruin the other. There is a saying in Argentina: "Power is like drinking gin on an empty stomach." You feel dizzy, you get drunk, you lose your balance, and you will end up hurting yourself and those around you, if you don’t connect your power with humility and tenderness. Through humility and concrete love, on the other hand, power – the highest, the strongest one – becomes a service, a force for good.

    The future of humankind isn't exclusively in the hands of politicians, of great leaders, of big companies. Yes, they do hold an enormous responsibility. But the future is, most of all, in the hands of those people who recognize the other as a "you" and themselves as part of an "us." We all need each other. And so, please, think of me as well with tenderness, so that I can fulfill the task I have been given for the good of the other, of each and every one, of all of you, of all of us.

  • The Surgeon General’s prescription of happiness (TEDMED talk)

    The Surgeon General’s prescription of happiness (Dr. Vivek Murthy)

    Disagreement With This Video (By Editor, Phillip W. Long MD)

    I have been trained in public health as well as psychiatry, and I strongly disagee with those in public health, like the U.S. Surgeon General, who fail to mention that our greatest public health emergency is climate change. I believe that it is absurd to suggest, as the U.S. Surgeon General has, that severe public health problems (like childhood poverty causing poor academic achievement) can be fixed by simply teaching students gratitude and meditation. The Surgeon General mentions that this approach was tried at San Francisco's Visitacion Valley Middle School, and it was a great success. This is incorrect. Currently, 80% of San Fransisco's middle schools academically perform better than this school. I invite you to watch this video by the Surgeon General, then compare it to the next video given by Dr. Courtney Howard.

    Happiness Increases Health

    If there was a factor in your life that could reduce your risk of having a heart attack or stroke, that could increase your chances of living longer, that would make your children less likely to engage in crime or use drugs, and that would even increase your success in losing weight, what would that factor be?

    It turns out, it would be happiness.

    By happiness, I don't mean the feeling that comes from indulgence or hedonism, I mean the long-term emotional well-being that comes from fulfillment, purpose, connectedness and love.

    Happiness affects us on a biological level. Happy people have lower levels of cortisol, a key stess hormone. They have more favorable heart rates and blood pressures. They have stronger immune systems, and they have lower levels of inflammatory markers, like c-reactive protein which has been linked to coronary heart disease.

    It turns out, even when you control for smoking, physical activity and other health behaviors, happy people live longer. There's something about happiness that seems to be protective.

    Now I want to be clear. White happiness is an important factor in improving health, it's certainly not the only one. We know that good nutrition, exercise, and sleep are essential tools for preventing illness. Whether we are living with depression or with diabetes, treatment is essential too. Yet among all these factors for improving health, happiness stands out as a largely untapped and unrecognized resource that has the potential to transform health for individuals and for communities...

    (As a physician) the most common condition I treated was unhappiness. It stems from isolation, from lack of meaning, and from a loss of self-worth... (People) are constantly surrounded by news stories and narratives that only remind them time and time again of all the things they have to be worried about. All this unhappiness is important because unhappiness is a risk factor for illness.

    You may ask yourself does happiness really lead to better health? Isn't it the other way around? Doesn't happiness result from good health and favourable circumstances? We may sometimes think, I'll be happy if only I lose 15 more pounds, or if I get a better job, or if I make just a little more money. But the truth is happiness if far more driven by how we process life events than by the events themselves.

    So if happiness is protective, the key question is, can we create it. The answer is yes, and the way we do that is surprisingly simple, and it largely costs nothing.

    Gratitude

    The research tells us that gratitude exercises, meditation, physical exercise, and social connectedness are just a few of the tools we can use to increase happiness. Take gratitude for example, one study participants and randomized them to three different groups. In one group, the gratitude group, participants were asked to write down five things they were grateful for. In the second group, the hassle group, the participants were asked to write down 5 things that hassled them. In the third group, they were asked to write down five things that happened without a positive or negative slant.

    Now at the end of ten weeks, it turns out the participants in the gratitude group experience a greater level of optimism, and they had a more positive view of their life. But they also exercise by 1.5 hours more on average per week. They also slept better, and they had fewer physical symptoms like pain, nausea, and headaches.

    The simple practice of gratitude had the power to increase their happiness and to change their health behavior and their health outcomes.

    Meditation

    Perhaps one of the most powerful examples of cultivating happiness comes from Visitacion Valley Middle School in San Francisco, California.

    Some years ago, Visitation was struggling. They were struggling with low test scores, with high suspension rates, and with so much community violence that they had to hire a full time grief counselor at the school. They tried all kinds of things to help. They started after-school programs, sports programs, peer counseling programs, but all without much luck.

    Then one day they decided to take a leap of faith. What if, they asked themselves, we use meditation as a tool to reduce stress and increase happiness for our students? So they created two 15-minute quiet time meditation sessions during each school day. They taught the teachers and the students how to meditate. They taught the administrators how to meditate as well.

    Within a year, something incredible happened. Suspension rates dropped by 45%. Teacher absenteeism dropped by 30%. Test scores and grade point averages rose markedly. The students reported they were less anxious and they were sleeping better.

    The self-reported happiness scores of the students went from one of the lower scores in San Francisco to the highest score in the entire district. As one student put it, "our school went from being a place of anger, sadness, and fear, to a place where we could be happy"....

    The Visitacion Valley Middle School model is being replicated at other schools now with comparable results. What is so striking about these tools for increasing happiness, meditation, gratitude, social connection, and exercise, is that they are simple and accessible.

    We have become accustomed to thinking that complex problems require complex solutions. But that's not always the case. Sometimes simple solutions can enable us to take on some of our most intractable problems. That's what happiness can do when it comes to health.

    Creating Happiness In The Lives Of Others

    If you think about it, all of us have the power to create happiness in our lives. But we also have the power to create happiness in the lives of others. If you need proof of this, I'd ask you to join me in a short exercise I learned from the legendary Mr. Rogers (host of a children's show).

    Close your eyes for 10 seconds with me and think about the people who have brought kindness, understanding, and joy into your life over the years - the people you remember that helped you to be happy. [audience pauses 10 seconds to do this]

    I remembered my wife Alice, my mother, my father, my sister. They have brought happiness, joy, and health into my life for so many years. Each of us has the power to touch other people's lives. Sometimes it's just a simple gesture or a kind word.

    Imagine if happiness and emotional well-being were prioritized in our schools as much as test scores and grades. Imagine if cultivating happiness was a priority in our workplaces. Imagine if our policymakers understood emotional well-being to be the fuel that enables us to be healthy, productive, and strong.

    So as we grapple with the challenges of how to create a healthier, stronger world, let us remember that happiness is a powerful tool for health. Let us remember that we can create happiness in our lives, and in the lives of the people around us. Let us call ourselves and each to action to ensure that emotional well-being is part of our policies, part of our institutions, and part of our way of life.

    If we do this, we will create a world that is full of joy, a world that is full of health, the world that our children deserve.

  • Healthy Planet, Healthy People: Dr. Courtney Howard (TED talk)

    This talk puts the previous talk by the U.S. Surgeon General to shame. Dr. Howard correctly states that our greatest public health emergency is climate change. If our environment collapses, and we start to starve, teaching people to count their blessings and to meditate will do little. Dr. Howard lists the many things we can do to decrease climate change. (However, we don't know if it is already too late, but at least we can try. P.S. In April 2018, Cape Town South Africa will run out of water and its citizens may thus be forced to leave. For years, there has been a devastating drought in all of East Africa, most of the Middle East, and from there over to Vietnam. This drought has decimated food production - now many of these nations are on the verge of starvation. All of this is the result of climate change.)

  • What the 1% Don't Want You to Know (Moyers & Company)

    Our society is becoming uglier: increased homelessness, increased poverty, increased drug addiction, deterioration of public education, increased political polarization, and increased income inequality. This video explains how much of this societal ugliness can be traced back to the rapidly increasing concentration of wealth in the hands of a very few, extremely rich oligarchs. This interview is with the economist Paul Krugman, who won the Nobel Prize for Economics. (The fabulously rich oil- and coal-barons are denying climate change and are actively opposing restrictions on the burning of fossil fuels.)

  • Maybe we're dark: Andrew Brash (TEDx talk)

    Ambition can put the blinders on people, and drive us to sacrifice caring for others. Climber, teacher, and author Andrew Brash tells how he gave up his summit of Everest to save another climber's life. Looking back on this, Andrew now realizes the human cost of overarching ambition.

  • Medical miracle on Everest (TED talk)

    What makes this story so inspirational is that it is a story of heroism and self-sacrifice. How one climber could have survived, but instead died while trying to help his friend. How another climber knew that he was freezing to death, but chose to spend his final moments phoning his pregnant wife to say goodbye. How two climbers who were already in safety chose to climb back up Everest to rescue others. How one climber who was left for dead spent 36 hours covered by snow, then decided that he would not die this way, and actually made it down Everest to safety. This story illustrates just how noble people can be when they face death.

  • What keeps us happy and healthy as we go through life? (TED talk)

  • Fulfilling trauma's hidden promise (TEDMED talk)

  • What makes life worth living in the face of death (TEDMED talk)

  • Secrets of Centenarians (NHK Documentary)

    This documentary reports the findings of a scientific study on the factors that allow people to live past 100.

  • 10 ways to have a better conversation (TED talk)

    Ten ways to have a better conversation (Celeste Headlee)

    We've all had really great conversations. We've had them before. We know what it's like. The kind of conversation where you walk away feeling engaged and inspired, or where you feel like you've made a real connection or you've been perfectly understood. There is no reason why most of your interactions can't be like that.

    So I have 10 basic rules. I'm going to walk you through all of them, but honestly, if you just choose one of them and master it, you'll already enjoy better conversations.

    Number one: Don't multitask.

    And I don't mean just set down your cell phone or your tablet or your car keys or whatever is in your hand. I mean, be present. Be in that moment. Don't think about your argument you had with your boss. Don't think about what you're going to have for dinner. If you want to get out of the conversation, get out of the conversation, but don't be half in it and half out of it.

    Number two: Don't pontificate.

    If you want to state your opinion without any opportunity for response or argument or pushback or growth, write a blog.

    Now, there's a really good reason why I don't allow pundits on my show: Because they're really boring. If they're conservative, they're going to hate Obama and food stamps and abortion. If they're liberal, they're going to hate big banks and oil corporations and Dick Cheney. Totally predictable. And you don't want to be like that.

    You need to enter every conversation assuming that you have something to learn. The famed therapist M. Scott Peck said that true listening requires a setting aside of oneself. And sometimes that means setting aside your personal opinion. He said that sensing this acceptance, the speaker will become less and less vulnerable and more and more likely to open up the inner recesses of his or her mind to the listener. Again, assume that you have something to learn.

    Bill Nye: "Everyone you will ever meet knows something that you don't." I put it this way: Everybody is an expert in something.

    Number three: Use open-ended questions.

    In this case, take a cue from journalists. Start your questions with who, what, when, where, why or how. If you put in a complicated question, you're going to get a simple answer out. If I ask you, "Were you terrified?" you're going to respond to the most powerful word in that sentence, which is "terrified," and the answer is "Yes, I was" or "No, I wasn't." "Were you angry?" "Yes, I was very angry." Let them describe it. They're the ones that know. Try asking them things like, "What was that like?" "How did that feel?" Because then they might have to stop for a moment and think about it, and you're going to get a much more interesting response.

    Number four: Go with the flow.

    That means thoughts will come into your mind and you need to let them go out of your mind. We've heard interviews often in which a guest is talking for several minutes and then the host comes back in and asks a question which seems like it comes out of nowhere, or it's already been answered. That means the host probably stopped listening two minutes ago because he thought of this really clever question, and he was just bound and determined to say that. And we do the exact same thing. We're sitting there having a conversation with someone, and then we remember that time that we met Hugh Jackman in a coffee shop.

    And we stop listening. Stories and ideas are going to come to you. You need to let them come and let them go.

    Number five: If you don't know, say that you don't know.

    Now, people on the radio, especially on NPR, are much more aware that they're going on the record, and so they're more careful about what they claim to be an expert in and what they claim to know for sure. Do that. Err on the side of caution. Talk should not be cheap.

    Number six: Don't equate your experience with theirs.

    If they're talking about having lost a family member, don't start talking about the time you lost a family member. If they're talking about the trouble they're having at work, don't tell them about how much you hate your job. It's not the same. It is never the same. All experiences are individual. And, more importantly, it is not about you. You don't need to take that moment to prove how amazing you are or how much you've suffered. Somebody asked Stephen Hawking once what his IQ was, and he said, "I have no idea. People who brag about their IQs are losers."

    Conversations are not a promotional opportunity.

    Number seven: Try not to repeat yourself.

    It's condescending, and it's really boring, and we tend to do it a lot. Especially in work conversations or in conversations with our kids, we have a point to make, so we just keep rephrasing it over and over. Don't do that.

    Number eight: Stay out of the weeds.

    Frankly, people don't care about the years, the names, the dates, all those details that you're struggling to come up with in your mind. They don't care. What they care about is you. They care about what you're like, what you have in common. So forget the details. Leave them out.

    Number nine: Listen.

    I cannot tell you how many really important people have said that listening is perhaps the most, the number one most important skill that you could develop. Buddha said, and I'm paraphrasing, "If your mouth is open, you're not learning." And Calvin Coolidge said, "No man ever listened his way out of a job."

    Why do we not listen to each other? Number one, we'd rather talk. When I'm talking, I'm in control. I don't have to hear anything I'm not interested in. I'm the center of attention. I can bolster my own identity. But there's another reason: We get distracted. The average person talks at about 225 word per minute, but we can listen at up to 500 words per minute. So our minds are filling in those other 275 words. And look, I know, it takes effort and energy to actually pay attention to someone, but if you can't do that, you're not in a conversation. You're just two people shouting out barely related sentences in the same place.

    You have to listen to one another. Stephen Covey said it very beautifully. He said, "Most of us don't listen with the intent to understand. We listen with the intent to reply."

    Number 10: Be brief.

    "A good conversation is like a miniskirt; short enough to retain interest, but long enough to cover the subject." -- My Sister

    All of this boils down to the same basic concept, and it is this one: Be interested in other people.

  • An Example Of Mindfulness Meditation (10 minute video)

    In the 5th century BCE, Buddha spent 6 years of his life mastering mindfulness meditation. He then decided to look beyond meditation. Buddha concluded that simply emptying the mind of thought is calming, but otherwise it accomplishes little - since "You return to the same world". Instead, Buddha taught that we should change our world by seeking enlightenment through practicing compassion, and living a calm, peaceful, happy life.

  • 100 People: A World Portrait (TEDMED talk)

  • Mindfulness Training: A simple way to break a bad habit (TEDMED talk)

  • If we can’t cure the patient, can the community do it? (TEDMED talk)

  • What if "it's the environment, stupid"? (TEDMED talk)

Physical Exercise: Vital For Self-Help




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  • The best summary on bad research is given by Laura Arnold in this TEDx lecture. If you read nothing else about research, you owe it to yourself to watch this short video - it is excellent!

  • The power of asking "what if?"

  • The active placebo effect: 2300 years ago, the Greek Stoic philosophers taught that it is not the objective event, but our subjective judgment about the event, that determines our behavior. The active placebo effect bears witness to this ancient wisdom.

  • Criteria For High Quality Research Studies

  • It is troubling that a recent study found that two-thirds of important psychological research studies couldn't be replicated. High quality research must meet the following criteria:

    • Randomized Controlled Trial:
      Ask: Was the trial randomized? Was the randomization procedure described and was it appropriate? The best research design is to have research subjects randomly assigned to an experimental or control group. It is essential that confounding factors be controlled for by having a control group or comparator condition (no intervention, placebo, care as usual etc.).

    • Representative Sample:
      Ask: Do the research subjects represent a normal cross-section of the population being studied? Many psychological research studies using university students are flawed because their subjects are not representative of the normal population since they are all W.E.I.R.D. (White, Educated, Intelligent, Rich, and living in a Democracy).

    • Single Blind Trial:
      Ask: Was the treatment allocation concealed? It is essential that the research subjects are kept "blind" as to whether they are in the experimental or control group (in order to control for any placebo effects).

    • Double Blind Trial (Better Than Single Blind Trial):
      Ask: Were blind outcome assessments conducted? In a double blind study, neither the research subjects nor the outcome assessors know if the research subject is in the experimental or control group. This controls for both the placebo effect and assessor bias.

    • Baseline Comparability:
      Ask: Were groups similar at baseline on prognostic indicators? The experimental and control groups must be shown to be comparable at the beginning of the study.

    • Confounding Factors:
      Ask: Were there factors, that weren't controlled for, that could have seriously distorted the study's results? For example, research studies on the effectiveness of mindfulness cognitive therapy in preventing depressive relapse forgot to control for whether the research subjects were also simultaneously receiving antidepressant medication or other psychological treatments for depression.

    • Intervention Integrity:
      Ask: Was the research study protocal strictly followed? The research subjects must be shown to be compliant (e.g., taking their pills, attending therapy) and the therapists must be shown to be reliably delivering the intervention (e.g., staying on the research protocol).

    • Statistical analysis:
      Ask: Was a statistical power calculation described? The study should discuss its statistical power analysis; that is whether the study size is large enough to statistically detect a difference between the experimental and control group (should it occur) and usually this requires at least 50 research subjects in the study.

      Ask: Are the results both statistically significant and clinically significant? The results should be both statistically significant (with a p-value <0.05) and clinically significant using some measure of Effect Size such as Standardized Mean Difference (e.g., Cohen's d >= 0.33). The summary statistics should report what percentage of the total variance of the dependent variable (e.g., outcome) can be explained by the independent variable (e.g., intervention). In clinical studies, the study should report the number needed to treat for an additional beneficial outcome (NNTB), and the number needed to treat for an additional harmful outcome (NNTH).

        Number Needed To Benefit (NNTB): This is defined as the number of patients that need to be treated for one of them to benefit compared with a control in a clinical trial. (It is defined as the inverse of the absolute risk reduction.) Note: Statistically, the NNTB depends on which control group is used for comparison - e.g., active treatment vs. placebo treatment, or active treatment vs. no treatment.

        Number Needed To Harm (NNTH): This is defined as the number of patients that need to be treated for one of them to be harmed compared with a control in a clinical trial. (It is defined as the inverse of the absolute increase in risk of harm.)

        Tomlinson found “an NNTB of 5 or less was probably associated with a meaningful health benefit,” while “an NNTB of 15 or more was quite certain to be associated with at most a small net health benefit.”

      Ask: Does the researcher accept full responsibility for the study's statistical analysis? The researcher should not just hand over the study's raw data to a corporation (that may have $1,000 million invested in the study) to do the statistical analysis.

    • Completeness of follow-up data:
      Ask: Was the number of withdrawals or dropouts in each group mentioned, and were reasons given for these withdrawals or dropouts? Less than 20% of the research subjects should drop out of the study. The intervention effect should persist over an adequate length of time.

    • Handling of missing data:
      Ask: Was the statistical analysis conducted on the intention-to-treat sample? There must be use of intention-to-treat analysis (as opposed to a completers-only analysis). In this way, all of the research subjects that started the study are included in the final statistical analysis. A completers-only analysis would disregard those research subjects that dropped out.

    • Replication of Findings:
      Ask: Can other researchers replicate this study's results? The research study's methodology should be clearly described so that the study can be easily replicated. The researcher's raw data should be available to other researchers to review (in order to detect errors or fraud).

    • Fraud:
      Ask: Is there a suspicion of fraud? In a research study, examine the independent and dependent variables that are always measured as a positive whole number (e.g., a variable measured on a 5-point Likert-type scale ranging from "1 = definitely false to 5 = definitely true" etc.). For each of these variables, look at their sample size (n), mean (M) and standard deviation (SD) before they undergo statistical analysis. There is a high suspicion of fraud in a study's statistics:

      • If the M is mathematically impossible (online calculator): This is one of the easiest ways to mathematically detect fraud. The mean (M) is defined as "the sum (Sum) of the values of each observation divided by the total number (n) of observations". So: M = Sum/n. Thus: (Sum) = (M) multiplied by (n). We know that, if a variable is always measured as a positive whole number, the sum of these observations always has to be a whole number. For these variables to test for fraud: calculate (M) multiplied by (n). This calculates the Sum which MUST be a positive whole number. If the calculated Sum isn't a positive whole number; the reported mean (M) is mathematically impossible - thus the researcher either cooked the data or made a mistake. A recent study of 260 research papers published in highly reputable psychological journals found that 1 in 2 of these research papers reported at least one impossible value, and 1 in 5 of these research papers reported multiple impossible values. When the authors of the 21 worst offending research papers were asked for their raw data (so that its reliability could be checked) - 57% angrily refused. Yet such release of raw data to other researchers is required by most scientific journals. (Here is an example of a research paper filled with mathematically impossible means.)

      • If the SD is mathematically impossible (online calculator): When researchers fraudulently "cook" their data, they may accidently give their data a mean and standard deviation that is mathematically impossible for a (normally distributed) strictly positive variable (because the "cooked" M and SD would mathematically require the strictly positive variable's range of data to include negative numbers). For a normally distributed sample of size of 25-70, this occurs when the SD is greater than one-half of the M; for a sample size of 70+, this occurs when the SD is greater than one-third of the M [using these formulas].

      • If the SD/M is very small (i.e., the variable's standard deviation is very small compared to the mean suggesting data smoothing).

      • If the SD's are almost identical (i.e., the variables have different means but almost identical standard deviations).

      • If the 4th digit of the values of the variables aren't uniformly distributed - since each should occur 10% of the time (Benford's Law).

      • If the researcher is legally prevented from publishing negative findings about a drug or therapy because that would violate the "nondisclosure of trade secrets" clause in the research contract (i.e., it is a "trade secret" that the drug or therapy is ineffective - hence this can not be "disclosed"). Approximately half of all registered clinical trials fail to publish their results.

      • If the researcher refuses to release his raw data to fellow researchers (so that they can check its validity). In order to be published in most scientific journals, a researcher must promise to share his raw data with fellow researchers. Thus a researcher's refusal to do so is almost a sure indicator of fraud.

      • If the research study's data contradicts the study's own conclusions - surprisingly, this often occurs.

  • Calling Bullshit In The Age of Big Data - "Bullshit is language, statistical figures, data graphics, and other forms of presentation intended to persuade by impressing and overwhelming a reader or listener, with a blatant disregard for truth and logical coherence." Reading the syllabus of this university course should be required reading for every student of mental health. This syllabus is absolutely fantastic!

  • Statistical Methods in Psychology Journals: Guidelines and Explanations - American Psychologist 1999

  • Not All Scientific Studies Are Created Equal - video

  • The efficacy of psychological, educational, and behavioral treatment

  • Estimating the reproducibility of psychological science

  • Psychologists grapple with validity of research

  • Industry sponsorship and research outcome (Review) - Cochrane Library

  • 'We've been deceived': Many clinical trial results are never published - (text and video)

  • Junk science misleading doctors and researchers

  • Junk science under spotlight after controversial firm buys Canadian journals

  • Medicine with a side of mysticism: Top hospitals promote unproven therapies - Are some doctors becoming modern witchdoctors?

  • When Evidence Says No, But Doctors Say Yes


  • Cochrane Reviews (the best evidence-based, standardized reviews available)


Research Topics




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