Giving Thanks After Thanksgiving…How an Attitude of Gratitude Will Change Your Life

The last of the mashed potatoes have been scraped from the Tupperware, the can shaped cranberry sauce somehow looks even more like a science experiment as the gelatinous blob splatters in the trash can. Every remnant of Thanksgiving is gone.

Are we still thankful?

For many, the spirit of giving, kindness, and joy lasts through December. Suddenly when the last string of tangled lights has been placed back in it’s designated box to collect dust into until next year, we seem to pack that sense of joy, gratefulness, and compassion along with it.

Why?

I thought about this as the stuffing, pumpkin pie, and green bean casserole rumble in my stomach. It’s easy to be grateful when we’re reminded to be. Now, I don’t think this is because humans are innately selfish or ungrateful. I reflect on the countless sessions I’ve had with patients and many stressors, obstacles, traumas, and heartbreak fill our daily lives. Something I find myself echoing to many patients when they express shame, or even guilt about seeking treatment is that: we live hard lives. It can be argued that many of those stressors are ‘first world problems’ and they might be, but it doesn’t make them any less real when we experience them.

We live in a world where we’re expected to work harder, work longer hours and to be constantly connected to our jobs. We’re inundated with carefully curated photos that convince us that everyone but us lives the perfect, magical, happy-at-all-times lives. Heavily edited and filtered photos cover our screens, and tell us no one else has wrinkles, or cellulite, or blemishes. We see nothing but smiling picture perfect families that tell us we must be awful parents because our kids would never wear those disgusting saccharinely sweet matching pajama sets, let alone smile together in the same picture.

All of these stressors don’t disappear during the holidays, however at this time went tend to be more generous and patient, often we donate more of our time and money. Most people at some point during the holiday season will sit around the table with loved ones and share something we’re thankful for. The calendar turning to November doesn’t magically change the stressors and challenges we have, however one thing is different. We are essentially forced to reflect on what we have to be thankful for, whereas the rest of the year we don’t often have similar prompting.

Our perception and thoughts are powerful things. Our thoughts and beliefs are much like the old saying “birds of a feather flock together,” or “like attracts like.” The more negative or irrational thoughts we have, the more they seem to multiply, the same being true for positive thoughts.

One trick that I like to teach patients is how the change of a very simple word in our thinking can alter our entire perception. Changing “have” to “get” can completely change the context and our thinking of a situation.

Flipping, “I have to go to work today,” to “I get to go to work today” elicits a very different feeling. It makes me think of something my dad said years ago while he was working a job that came with some pretty severe stressors, “I might not like my work, but if I didn’t have a job, I’d sure want this one.”

During the holiday season we’re literally told to ‘give thanks’ or ‘be thankful’ hundreds of times. I find the happiest people are the ones who think of something to be grateful for the instant their feet hit the floor in the morning.

So give thanks this holiday season, and enjoy the festivities, but especially if you’re struggling with any kind of mental or emotional pain, I invite you to accept the challenge of starting every day, this holiday season and beyond, with something, no matter how small, that you can be grateful for.

You might find it’s not as hard to face the work day, your kids aren’t as exhausting, you may just feel better about yourself and life overall.

And with that… I’m thankful for you reading this 😉

The Opioid Epidemic and Substance use, What’s it All About?

Recently, I was at a concert with some friends, I noticed the floor was slick, and warned my best friend, “Be careful, the floor is really slippery, don’t fall.” Within five minutes I reinforced the sentiment that my parents should have named me “Grace,” a joke they have made since I was a small child. I slipped, fell, and ended up fracturing my fibula and required surgical repair. This resulted in having to reschedule my planned trip to Thailand. So, being relatively immobile, in a fair amount of pain, and having pain medication and addiction being frequent topics of recent conversation, I figured this would be a good opportunity to explore opioid use and the controversial topic of naloxone/Narcan.

Over the last few years there has been a pretty heated debate on whether Narcan should be more readily available for people suffering from opioid addiction and/or their friends/family members. So what’s the problem, and what is naloxone?

Naloxone is an opioid antagonist, meaning it is something that counteracts the action of opioids. Opioids are substances like heroin, oxycodone, hydrocodone, etc. that bind to specific receptors in our brains. A benefit of opioids is the binding of opioids to these sites results in pain relief, however danger comes because this can result in a sense of euphoria which can trigger a very intense reward system in our brains thus potentially leading to addiction/abuse/misuse.

Basically naloxone acts as opioid “police” or “bouncers.” Imagine opioids as underage kids at a wild party, the job of naloxone is to round them all up and boot them out. Naloxone is often used for rapid opioid reversal in an emergency situation (kind of like an antidote). Since an opioid overdose can cause respiratory depression and coma it can be deadly, naloxone can reverse the action of opioids and prevent these lethal outcomes.

So what’s the controversy? There has been a push to make this medication readily available for people with substance use disorders and/or friends/family members to have on hand so that it may be administered in case of an overdose. Some argue that making this medication readily available will only encourage people to start or continue using opioids because the risk of overdose would be significantly reduced. Now, everyone is certainly entitled to his/her own opinions and beliefs, however to me this seems very similar to arguments that we shouldn’t have sex education, make contraception available, or administer the HPV vaccination to children because “it will only encourage them to engage in these behaviors.” In my belief, the more education someone has on a matter the better informed they are and thus make more educated/informed decisions and multiple studies support this.

This gets a little tricky in regards to substance use because the decision making/reward system parts of our brain are exactly what gets affected by substance use. Most frequently overdoses occur in a few situations: 1. a person has been using a substance, tolerance has developed, as a result of continued use, higher doses of the substance are required to get the desired “high” a person is seeking, or 2. a person has been using a substance, he/she sustained some period of sobriety and relapse, using the same amount of substance in question, however since there has been time without use of the substance some of that tolerance has gone away (meaning it won’t take as much to get the same high), the body gets overwhelmed and overdose results. Now this doesn’t mean it’s impossible to overdose on the first use of a substance, or that there aren’t some people who may try a substance because there is some kind of perceived safety net, however in my professional experience this is not the majority of cases.

So what should you know about Naloxone?

It is an opioid antagonist a.k.a. it is the opioid police. Imagine the chaos of people fleeing a party and getting put into a police car when the cops show up.
It is unpleasant, uncomfortable chaos. When naloxone comes on board, it basically displaces all the opioids from where they have bound which is UNCOMFORTABLE. One reason opioid use is so hard to kick is the withdrawal. Naloxone essentially makes a person go into instant withdrawal, which is NOT FUN.
There is no “high” with naloxone. There is no intrinsic reward that comes from naloxone use. If anything, say someone hypothetically was experimenting with opioids knowing he/she had this perceived safety net, the sheer discomfort of this instant withdrawal would in itself likely be a deterrent from future use.

One of the most important things I hope to leave people with is a better understanding of substance use. Generally speaking, people do not start using/abusing/misusing substances when things in his/her life are going fantastically. The majority of times substance use is a maladaptive coping mechanism used to numb some kind of intolerable emotional pain. What I frequently remind family/friends of is THIS IS NOT AN EXCUSE, rather an explanation of behaviors.

So why do some people become addicted and others don’t? This is a complicated question with no easy answer. However there are physiological changes that happen in our brain when we use substances. It may start as “Hey this feels good, and helps me get away from the **** going on in my life right now” which we can call ‘impulsive behavior’ a specific part of the brain is activated in this process. However when it shifts to compulsive behavior ‘I need this to get me through the day and you are going to be in massive suffering/you are going to die if you don’t get [substance, A,B,C,D, etc.] an entirely different system in our brain is activated.

Ok, so what flips the switch from impulsive to compulsive? A bunch of different things. However one of the most important seems to be social supports. There have been animal studies that have animals both exposed to addictive substances. One with a very uncomfortable environment with limited supports, the other with a significantly more supportive environment. While the subject in the supportive environment may try the addictive substance, the same kind of dependence doesn’t occur. This is not to say this is the only factor, but it is a key one.

There was a stand-up bit I saw YEARS ago where the comic poked fun saying “Alcoholism is the only disease you can get yelled at for having.” Every once in a while I need to let this sentiment sink in and resonant with me, and something I will tell you is that it makes me angry. It makes me angry at what a poor job we do of educating others on substance use, and treating it as what it is, a psychiatric/physiological condition that should be treated with the same understanding, compassion, and concern that any other kind of medical condition is instead of as a ‘character defect.’

It may be easy for people to scoff at this and continue to lack compassion, but what I would say is if you are able to exert enough energy to have contempt or distain for people suffering from these conditions and say “Well why don’t you just go get help?” Why don’t you just get a job?” I challenge you to earnestly speak to someone or the family member of someone who has been struggling with a substance use disorder.

Does the woman now addicted to heroin who was eight years old when she was shot up with heroin for the first time and forced into prostitution by her dad deserve public ridicule or disdain? What about the (wo)man who spent years of his/her life sending and receiving gunfire in war zones who comes home and ends up finding his/her only escape pain medication prescribed to treat injuries he/she sustained? What about the doctor or the lawyer who comes home after days on end of shouldering the emotional burden of each and every one of his/her patients/clients and can find no solace outside of a whiskey bottle? Likely we don’t see these people the same way we do the indigent person downtown carrying all of his/her worldly belongings in a shopping cart. However it’s relatively rare for someone passing these judgements (out of distain, discomfort, fear, or whatever) to actually speak to these people like the actual living, breathing human beings they are. If we look at the actual science and neurochemistry that is involved in addiction there is absolutely no question this is an actual disease, not a character defect, and we need to start treating it as such.

My opinion is that I have seen more than enough people struggle with addiction in both my professional and personal life. Narcan saves lives. It is something that is INCREDIBLY uncomfortable to be administered during an overdose, people do not get a high off of it, people don’t feel good after using it. Withdrawal is something so uncomfortable and so powerful that it is a perpetuating factor in addiction… going into instant withdrawal is not desirable. Remember, people go to EXTREME lengths to avoid symptoms of withdrawal.

My final question or thought would be, if a medication is available to save the life of a person with a potentially life threatening condition why would we not make it available? If it was your child/sibling/significant other/friend/etc. who was struggling with an addictive disorder and had the possibility of dying of an overdose, would you not want something available to save his/her life?

Please, comment, share, subscribe, ask any addiction/mental health questions! I

 

f you or someone you know is experiencing a mental health/substance use condition contact the national mental health and substance abuse hotline
SAMHSA’s National Helpline – 1-800-662-HELP (4357)

Body Positivity: What it is, What it isn’t, and How to Get There

Over the last few years body positivity is something that has been getting a lot of attention. Supporters of this movement have the stance that this helps improve a person’s self esteem and overall wellbeing, and reducing judgment. However there is also the thought that this puts people in danger of ignoring larger health problems. So who’s right? Both, well, kind of.

When I explain body positivity to patients I describe it as loving and accepting yourself for where you are currently at. This doesn’t mean you get to put blinders on and ignore any health issues you are experiencing. It is rather that accepting of you where you are at. Feeling guilt, shame, or anger towards yourself certainly will not resolve these issues. Let’s take a step back and look at our body in a different way. Imagine your body as a car. Let’s say for whatever reason, you hate this car. If you have negative feelings towards it it probably won’t be a priority to take it to the car wash, you may not care that there’s trash strewn about, it might be easy to ignore that maintenance light. What happens? The car further deteriorates. Now imagine your dream car. Do you treat it the same way? Probably not. You probably will ensure maintenance is kept up, take it through a car wash, maybe even put premium fuel in it.

We cannot take care of something we don’t value, and our bodies are no exception to this.

Valuing ourselves means valuing our bodies and this is something we need to start prioritizing in childhood. I got started thinking about this earlier this month when I was getting a massage. Ok, so the best way I can describe this message was an hour of being pinched, tickled, and poked. It was awful. I hate to admit this, but it took me a lot longer than it should have to speak up. While laying on the table I remembered having the thought “Why am I not saying something? This is in no way enjoyable. You are paying for this come on.” I realized how ridiculous it was for me to be valuing the feelings of a person (who I was paying to perform a specific service) over being uncomfortable with something that was happening to my body. We need to start instilling this from a very young age; if your child does not want to hug a friend/relative/whoever he/she does not have to! When we force or pressure our kids into things like this it starts a thought process that your body is not as valuable as someone else’s feelings/wants/needs.

Traveling is one of my big passions, and I like to think it is something that helps me think on a more global level and fuels the fires of curiosity. So when thinking about all of this I began to wonder about different things that affect the perception of our body’s value. Thailand is one of the most (if not the most) infamous areas for sex tourism/sex trafficking/sex work, etc. I began to question how having this be such a prominent part of a culture affected people’s sense of self worth. How do people involved in these industries perceive and feel about themselves, how do others view the individuals working in this industry? I’m so excited to say this is something I will be fortunate enough to explore at the end of September, so check back to see what the experience is all about!

Tips for Adopting a Body Positive Mindset

1. Place a sign, post-it note, whatever on your mirror with a positive message for yourself. I love having people put something like “Hello, gorgeous” up. This is helpful for a few reasons. One being that it starts your day with a positive thought about yourself. It begins to make you feel comfortable with thinking/feeling/accepting nice things about yourself. The more that we practice this, and replace negative self talk with these thoughts the more second nature it becomes.
2. Focus on health and wellness not numbers. We can get so tied up in wanting to hit that magic number on the scale that sometimes we neglect what is more important, overall health. If you start treating your body like that brand new car I talked about earlier, guess what happens? We start putting higher quality fuel in, we’re more attentive to regular maintenance (exercise, time to de-stress, etc.) and we overall perform at a higher level.
3. Adopt an attitude of gratitude. An exercise I commonly have patients struggling with this do is body mapping. So either draw or list it out, head to toe write something that you like about each body part. If you cannot think of something you like about a particular body part write something that you can appreciate about it (eg. you may not like your stomach but you can appreciate that it houses organs that digest food to nourish you).

Just remember, you deserve the same love, kindness, and compassion you give to others, so be kind to yourself!