Mindfulness

I recommend a daily three-minute gratitude ritual.  This starts with quieting your mind by paying attention to your breathing to help you become aware of the moment.  Here’s my favorite ritual.

With each slow breath, I say:

Thank you God for this moment,

Thank you God for this place,

Thank you God for the water,

Thank you God for the air,

Thank you God for the light,

Thank you God for this life.

Thank you God, Thank you God, Thank you God.

In place of God you can thank the Great Spirit, the Great Mother, Allah or whatever force you believe has given you these gifts.

Exercise

I recommend at least three minutes of daily exertion.  Exertion means you are breathing so hard you can’t have a conversation.  This may involve running up and down stairs, doing push-ups, crunches, and squats (modified as needed), or running in place.  You don’t need to change your clothes (sweat from exercise doesn’t stink like sweat from anxiety), and you can do your exercise of choice before lunch, between meetings, or when you first get home.  No one will miss you for three minutes (okay, maybe a crying baby or puppy).  And whatever exercise you enjoy or do routinely, but ALWAYS do at least three minutes of exertional exercise daily.  You’ll be amazed and pleased by the results – within weeks you’re likely to feel stronger, more toned, and more energetic.  Exercise is one of the best MEDs you can take!

Diet

I recommend you avoid sugar to reduce mood fluctuation.  By curtailing your intake of sugar, you’ll have more consistent energy, and you’ll lower your risk for diabetes, hypertension, and heart disease.  You’ll feel better and live longer!  No matter what diet you follow, whether it’s gluten-free, Mediterranean, vegetarian, vegan, or Paleo, you’ll feel better and you’ll be healthier if you eliminate sugary sweets.

Stress Management

I recommend saying NO!  Say no to unnecessary activities.  Say no to unnecessary work and relationship drama.  Say no to requests for your time when it’s not crucial.  Say no to unhealthy urges.  But say YES to getting enough sleep, spending less than you earn, and surrounding yourself with kind and loving people and animals as much as you can.

By consistently practicing these daily M.E.D.S., you’ll reduce your stress, feel good about yourself, and live longer!

Before you begin your “M.E.D.S.” be sure to discuss them with your healthcare provider.  It’s necessary to be sure that the activities you chose, particularly diet and exercise, do not cause you any harm.

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One of the most meaningful aspects of your life may be providing service to others. This could involve raising a child, caring for a parent or a pet, helping a friend or sibling, or performing service for your community or for an organization. Helping others may be a calling or an enjoyable sideline activity. Helping others can help you to feel connected and worthwhile.

Sometimes helping others goes too far. You might have an overdeveloped sense of responsibility or you might feel obligated and trapped. It’s easy to get out of balance when you help others. If you give too much, you can deplete yourself. If you don’t get enough back, you can feel resentful. If you feel you must shoulder someone else’s load, you can overwhelm yourself. If you do so much for others that you have little time for yourself, you can feel like you are suffocating.

Here are three things to keep in mind as you provide service to others. Practicing them will help keep you from feeling depleted:

          1.  Maintain a quid pro quo
          2.  Stream rather than contain the suffering of others
          3.  Take time to recharge

     Maintain a quid pro quo

Quid pro quo means “something for something.” It means that if you do something for someone, you receive something in return. When you do something for someone as a family member or friend, the usual expectation is that you are doing it altruistically and that you expect nothing in return. This is okay for a while, but eventually it will feel unfair and you will grow resentful.

Perhaps what you receive in return is a feeling of satisfaction, or that by “paying it forward” you are doing the right thing. Maybe you believe your payback will come later from some other person’s good deed, or that your service will pave your way to heaven.

Most generous acts are performed with no expectation of a return. The giver feels good about giving, especially if the receiver appears to benefit or voices gratitude. That’s adequate payment if you have a generous heart and if you feel you have more than you need.

If you give consistently more than you receive and if you have no source of spiritual nourishment for it, eventually your emotional health could suffer. That is why it is important to try to maintain a balance. If you consistently give more than someone else and you feel drained by it, you may need to give less or ask for more in return. Over the long run, a balanced quid pro quo will help you maintain balance in your relationships and balance in your mind.

     Stream the suffering of others rather than trying to contain it.

Suffering usually comes down to a question of ownership. Can you really own someone else’s suffering? The simple and obvious answer is no … but letting go of the urge to help can be difficult. Witnessing someone’s suffering with compassion and constructive concern is not easy. It requires clarity and usually quite a bit of practice.

If your words and/or your actions are the cause of someone’s pain, it is right to take responsibility. If apologizing  does not add to the hurt, doing so will probably help. Taking action to repair damage you may have done is also a good idea if it does not compound the problem or place you in an overly compromised position.

If you are not responsible for someone else’s suffering, it is not yours to mend.  Becoming a witness to someone else’s suffering and offering observations and suggestions, however, can be extraordinarily helpful and healing for both parties. Having compassion for the suffering of someone you love or care about is right and good. Going about it in a way that does not harm you is necessary.

It might help for you to visualize yourself as a rock in a stream. As someone’s suffering comes into your awareness, witness it with compassion and loving-kindness. Remarking on it and reflecting observations about it as it flows around you can give great comfort to the sufferer without taking too much from you. Give as much as you feel is right for you, and sustain your own presence as their distress flows around you. Know that they own their discomfort or suffering, and wish for them a deepening of awareness and a resolution.

It’s possible for you to remain comfortable and within your own place as you offer kindness and support to someone you love. If you do this by streaming and not by containing, you will have room in your heart to continue to be present for them. In this way, you can be present for someone without losing yourself.

     Take time to recharge

Whether you do so alone or with others, taking time to recharge your batteries is vitally important. Consider this a quid pro quo for yourself. When you have expended a great deal of energy in helping others, it is only reasonable that you take some time to resupply your energy reserves. The emotional labor required in many interactions can be extraordinarily depleting. You will need some time to reconstitute yourself with enjoyable time on your own or with people who expect little or nothing of you.

When you take the time to take care of yourself with these three simple steps, you’ll be able to show up for those in need without draining yourself and without resenting others for it. You’ll be able to find meaning and fulfillment as you provide service for others.

HOW TO HELP OTHERS

WITHOUT DEPLETING YOURSELF

MAINTAIN A QUID PRO QUO

Keep a balance of giving and getting in your relationships.

It is important to get back as much as you give out.

STREAM RATHER THAN CONTAIN

THE SUFFERING OF OTHERS

Witness with compassion and loving kindness the suffering of others

without trying to take it for them.

Take responsibility for any pain you may cause but do not try to own

someone else’s misery.

TAKE TIME TO RECHARGE

Whether it be alone or with others, find ways to recharge your

batteries when you feel depleted.

The post How to Help Others Without Depleting Yourself appeared first on Bick Wanck MD & Associates.

Careers, families and health are too often needlessly destroyed.  Craving and denial can be so powerful that alcoholism’s victims become locked in its embrace with little hope for escape unless they find help.

It’s easy to be fooled by alcoholism.  This great imposter can mimic mild to severe states of anxiety and depression, confusing even the most discerning observer.  Two weeks without a drop are often needed to know if there’s more going on than simple alcohol overuse.  On its own, simple alcohol overuse can result in symptoms of panic and despair rivaling the most severe cases of genetically driven mental illness.

Whether someone suffers with alcohol overuse alone or if it’s accompanied by another type of distress, the first step is conceptually simple but not easy – to stop drinking and to stay stopped.  Abstinence is the only sure way to be free of alcohol’s cunning and determined grasp.

Some people become aware that their drinking has gotten out of hand, while others need firm encouragement to realize they have a problem and to find a way out.  Most people start by trying to control their drinking.  If they don’t have genetic alcoholism or if they haven’t set the machinery of alcoholism in motion, they sometimes succeed.  By lowering stress and working through relationship drama, they sometimes manage to reduce their urge and curtail their use.  Many people, however, go through several attempts to restrict their drinking before realizing their drinking pattern is beyond their control.

Then what?

Some people turn to sober friends and go to AA for support.  Others seek counseling.  Some, who drink large amounts, must go for detox.  Medical detoxification may be needed for someone who drinks more than a pint of spirits, a liter of wine or a 6 pack of beer per day.  Without medically supervised detoxification, the risk of seizures or more severe complications of withdrawal may be too great.  Anyone unsure of their detox status should seek professional advice.

Repetitive efforts to abstain from alcohol and achieve sobriety sometimes results in success.  Too many times, however, tragedy strikes before the person has managed to establish a solid foothold in sobriety.  Automobile accidents, suicide, job firings and relationship unraveling can happen before some people manage to achieve sobriety.

There’s a path to sobriety often forgotten by harried clinicians or their patients:  disulfiram.  For many years and for many people, disulfiram (brand name Antabuse) has offered a quick way to become abstinent, the first step in the path to sobriety.

Within the context of a Three-Layered Healing Plan, disulfiram (Antabuse) is a Layer Three (Restoration with Medicine) decision.  I recommend you not rush this decision but consider it carefully.  In most cases, people are able to achieve a sober lifestyle with AA and, as needed, counseling.  Sometimes, however, particularly with stubborn cases of genetic alcoholism, people cycle through detox, counseling, and rehab numerous times.  They and their families can feel frustrated, desperate and scared.  Although there’s no guarantee that it will work, disulfiram (Antabuse) sometimes helps to create a period of abstinence long enough for the healing assists of healthy lifestyle, counseling guidance and spiritual AA guidance to take effect.

Disulfiram works by blocking aldehyde dehydrogenase, the enzyme that clears away acetyladehyde, a product of first stage of alcohol metabolism.  Acetyladehyde is a toxic molecule that, when not metabolized away, results in a severe reaction of facial flushing, accelerated heart rate, projectile vomiting and panic.  Anyone who drinks alcohol while under the influence of disulfiram, is unlikely to repeat the behavior because the disulfiram reaction is so severe.

Disulfiram mimics a genetic state called Asian flushing syndrome.  Although not restricted to Asians, a significant percentage (36%) of East Asians lack the gene that manufactures the enzyme that gets rid of acetyladehyde.  Because they can’t get rid of acetyladehyde, anyone with this genetic trait cannot tolerate alcohol.  If they were to develop an addiction, it would not be alcoholism.

Mimicing this genetic state by blocking the metabolism of acetyladehyde, disulfiram (Antabuse) leads to a nonnegotiable abstinence from alcohol.  This crude but very effective solution ensures abstinence for as long as disulfiram (Antabuse) is taken.  Plus, there’s a bonus:  the effect of disulfiram (Antabuse) lasts at least one week and often up to two weeks after the last dose of disulfiram is taken.  Even if someone thinks they want to return to drinking, this gives them time to reconsider their decision.

The disulfiram/alcohol reaction was first observed in an American tire factory in 1937.  Disulfiram, a sulfa compound, was used in the vulcanization (rubber manufacturing) process.  Factory workers inhaling disulfiram during their shifts were unpleasantly surprised they could not enjoy a drink after work because the disulfiram they inhaled on the job caused an unpleasant (and embarrassing) reaction at the bar.  This observation was reported by the occupational physician at the factory.  Later, in 1949, the molecule, was finally understood and isolated and was sold as Antabuse.

The dose of disulfiram (Antabuse) that works for most people is 250 mg taken at any time with or without food.  Occasionally people discover after taking alcohol, intentionally or not, that 250 mg is not sufficient to cause the full reaction.  In such cases, increasing the dose to 500 mg almost always works.

The disulfiram/alcohol reaction is unforgettable.  Within minutes skin flushing is accompanied by an accelerated pulse.  This is followed by intense vomiting and a sensation of panic.  It can be so bad that many people believe they are going to die and go to an Emergency Department for help.  Death is rare but disulfiram should not be used or should be used with caution for someone with a heart condition.

Although rare, if someone has an allergic reaction (rash, hives, and especially if trouble breathing), they should go to an Emergency Department for IV antihistamines and an anaphylactic reaction protocol.   Although there have been reports of liver toxicity, it appears that in most cases, the toxicity was caused by alcohol.  I have safely given disulfiram to people with cirrhosis but insist they be under the watchful eye of a gastroenterologist.

I caution people to not have a drink at least 12 hours before their first dose of Antabuse and then to avoid alcohol completely.  I write on a card or on a blank prescription that I have prescribed disulfiram for them and tell them to keep it with their health insurance card.   In case they have a severe reaction and pass out, Emergency Room staff will know the combination of disulfiram and alcohol may be a factor.

I caution people not to have rum cake (sometimes the rum is added after the cake is removed from the oven), to avoid ice cream cordials (liquor added), chocolates that may have liquor inside and never drink from the punch bowl at a party.  Some people who take disulfiram spray perfume or cologne on their hair rather than on their skin to avoid absorbing the alcohol in liquid fragrances.  They also ask for betadine rather than alcohol swabs when giving blood.  Those precautions I feel are unnecessary but some people feel safer by following them.  Please consult with your prescriber or pharmacist for additional information about the safe use of disulfiram.  Anyone considering using disulfiram (Antabuse) should do so only with the guidance of a prescriber knowledgeable about its use.

Disulfiram (Antabuse) can be a useful tool for ensuring abstinence until a program of recovery is undertaken and a state of sobriety established.  Some people use disulfiram only when they think a big event might lead them to drink.  They start it one week before the event (birthday, wedding, holiday gathering) and stop it after their urge has diminished and the immediate risk of relapse has passed.

Abstaining from alcohol with the help of disulfiram (Antabuse) should not be confused with sobriety.  Sobriety is a state of acceptance of the condition of alcoholism and surrender to a higher power to help maintain abstinence.  This is most often achieved by a recovery-oriented lifestyle, including active AA participation and the development of a daily ritual of reflection and renewed commitment to not drink.  Working with a “sponsor” (mentor) in AA, provides the guidance most people need to fully benefit from what AA has to offer.  Unfortunately, alcoholism has no cure and its management requires a lifetime of vigilance.

The spiritual guidance of AA harmonizes well with the emotional and cognitive guidance provided by psychotherapy.  In fact, it’s a good idea to add therapy to whatever efforts are being used to ensure abstinence and sobriety.  The top priority however, for anyone afflicted with alcoholism, must be abstinence.  Without it, any accomplishments, made in therapy are too easily thwarted by alcoholism’s relentless potential for relapse.  For someone who has trouble sustaining abstinence long enough to establish sobriety and a daily program of recovery, disulfiram (Antabuse) can be a useful tool.

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1. Would a medication help me heal or would it interfere with my healing process?

2. Are my symptoms so severe that they block my capacity to make good use of psychotherapy or other forms of healing guidance?

3. Might I have a hard-wired condition for which medication may be needed?

4. Is there a safe way to monitor my progress if I don’t take medication?

5. Would side effects and brain blunting caused by medication, outweigh its benefits?

These questions may not have easy answers but they are important to consider.  If medication is likely to help you heal, then it may make good sense to use it.  If it’s likely to interfere with your healing or cause dangerous side effects, then you may be better off without it.

Using these questions may help you and your healing team to decide whether your flow of healing needs to be restored with medication or whether it needs a boost with additional guidance or enhancements.  Questions such as these should be revisited anytime your healing flow seems stalled or blocked.  If you are not finding new awarenesses or some degree of relief, it could be that your healing is stalled.  Your healing may be blocked because your symptoms are too severe or it may be blocked because side effects of a medication are getting in your way.

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Too often, in the mad dash to relieve suffering, medication is prescribed before adequate consideration is given to what would be most helpful for healing. If long term resolution of suffering is the goal, will medication help it happen?

Psychiatric medication is often given to relieve painful emotional symptoms without knowing what may have caused the symptoms in the first place. It’s often given without knowing if experiencing those symptoms could be a necessary part of healing. Sometimes fear or despair need to be felt and worked through in order to be fully resolved. Taking a medication prematurely runs the risk of ruining an opportunity for long term resolution.

This does not mean that I am opposed to the use of medicine. Under the proper circumstances, medicine, whether herbal or pharmaceutical, can be a powerful tool to assist the process of healing.

Sometimes symptoms are so severe or a condition is so hard wired that healing becomes blocked. Severe symptoms can incapacitate healing by overwhelming one’s capacity to step back and gain perspective about what’s wrong and what to do about it. Medicine, when properly given, can reduce symptoms enough for healing to resume. If enough healing has happened, it may be possible to later taper and discontinue the medicine. One exception to this may be certain hereditary conditions that don’t respond easily to healing by non-medicinal means. In those circumstances, medication may be needed longer. Keeping excessively painful or troublesome symptoms at bay may then allow someone to address the other troubling dilemmas in their life.

Before making decision about psychiatric herbs or pharmaceuticals, it may be helpful to ask: Will this medicine assist my healing or get in its way? That simple question does not always have a simple answer. It may be necessary to reflect, research, and ask again.

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