[Editor’s note: This is by no means a definitive list. The comics featured here can not and do not represent everyone’s experiences. But there are some things they do capture. Part of the difficulty of depression is that it is a pain that is unnameable. Sometimes, art is the best way to capture the things we do not know how to say.]
CBC
News, (2013). Public health approach to bullying and suicide prevention urged:
Links between bullying, depression and suicide in youth examined in study.
This
test, based on the work of mental health experts Thomas H. Holmes and Richard
H. Rahe, helps you identify the sources and amount of stress you encounter in your
life. The following is a list of stress inducing events, in the order of their
Life Change Unit (LCU), from high to low. Note all the items that apply to
events you have experienced during the last year and add up their LCUs. Then
take a look at what you can do about your stress level.
For a lot of us, success in life starts with learning the right habits. And for parents, it’s essential to start children off on the right foot by teaching them good habits from an early age.
In fact, there’s one “habit” in particular that parents can pass on to their children – one that can help kids in many different ways, and that’s mindfulness.
Parents who introduce mindfulness to their kids can help them experience emotions, rather than react to them, and give them a way to identify their mental states before they become overwhelmed by them.
CAMH’s
brochure Common Questions about Trauma outlines what abuse-related trauma is,
how the effects of trauma develop, and why healing and getting help are
important.
We’ve just completed a new guide to help the family and friends of an individual who is struggling with a drug or alcohol problem. OurIntervention Guide, available as a free download below, offers information, tips, and advice for holding an addiction interventionand helping a loved one into treatment.
The guide lays out in simple terms:
What an intervention is
How to recognize over 20 “warning signs” that your loved one may be using drugs or alcohol
Who should be involved and what’s expected of each person
How to conduct the actual intervention discussion
How to write your own “intervention letter” (including a “fill-in-the-blanks” worksheet)
What to say to 14 of the most common objections that may arise
The new rules introduced by the federal government Thursday as part of what it's calling The Respect for Communities Act will make it harder for health care activists to open more supervised injection sites in this country.
What the federal government was unable to do at the Supreme Court of Canada in 2011 to shut down InSite on East Hastings - Canada's only supervised injection site available to the general public in Vancouver and the proliferation of such institutions across the country- it is now attempting to do with this act.
Reading through the initial press release from the Tory Minister of Health Leona Aglukkaq, it's clear Ottawa is continuing an attack that willfully ignores the mountain of scientific evidence based on 49 peer-reviewed papers published in scientific journals.
That evidence shows undeniable health benefits to both injection drug users and their communities that have resulted from InSite's presence in the Downtown Eastside over the past decade.
The federal health minister says "our government believes that creating a location for sanctioned use of drugs obtained from illicit sources has the potential for great harm in communities." But the facts tell a different story in our city.
Because injection drug users have a supervised place to shoot up where they come in contact with health care professionals, there has been an increasing number of referrals to health and social programs. There has also been a reduction in overdose fatalities; a reduction in the transmission of blood-borne infections like HIV and Hepatitis C; a reduction of injection-related infections. And, the police will tell you, a reduction in public disorder.
As well, obviously, there has been a reduction in health care costs.
InSite legally exists because of a special exemption from Ottawa so they can have illicit drugs on the premises. The Supreme Court ruling in 2011 said that failure to grant that exemption was a violation of Section 7 of the Charter of Rights that guarantees life, liberty and the security of the person. In other words, refusal to grant an exemption would endanger people's lives.
Ottawa continues to take the opposite view in The Respect for Communities Act. And the minister is clear that her government intends to "raise the bar" for applicants.
What they are asking for before an application for an exemption can even be "considered" is a demonstration of support from local law enforcement, municipal leaders, public health officials and provincial or territorial ministers for health.
The applicant would also have to include documentation showing that treatment options are available for those dealing with addiction. As far as Vancouver's InSite goes, it has had and continues to have support from all those areas. But what is now unknown is just how high the bar will be set by Ottawa in terms of the support. Would it require every elected official, every member of a community and every regional police force to sign on, for example?
And even then, applications could be rejected once considered.
The irony here, and one that Dr. Evan Wood with the B.C. Centre for Excellence in HIV/AIDS points out, is this: There are hundreds of needle exchanges in Canada supported by the federal government. These collect used needles and give out clean ones. Surely the government doesn't think this is a service that only meets the needs of diabetics.
So while it is willing to approve a service that allows addicts to shoot up in back alleys, unsupervised and often using water from puddles in their syringes, it's hesitant to approve a much more controlled environment.
In supervised sites, the user cannot take needles out into the street. They must fix in the presence of a health care professional. They must deal with drug counsellors who will engage them and encourage them to move on to treatment. And they must conduct themselves in an orderly fashion.
For some ideological reason that defies science and experience, Stephen Harper's government would rather support a system that puts people's lives at greater risk and is more damaging and costly to our communities.
This issue of Visions explores the theme of co-existing mental health
and alcohol/drug use problems from a number of different angles and includes
personal stories, approaches and models, regional programs in the community,
and resources.
A study by the University of Victoria shows alcohol consumption in B.C. is rising faster than in the rest of the country.
The study by the Centre for Addictions Research of B.C. indicates alcohol was responsible for an estimated 2,000 deaths in B.C. in 2009, and caused more than 20,000 hospital visits as a result of alcohol poisoning, falls or other injuries.
"Hospitalizations that are related to alcohol are a very good indicator of trends, of hazardous drinking and harm," said Dr. Tim Stockwell with the Centre for Addictions Research.
"They're probably the best measure we've got — better than surveys, better than desk data."
Stockwell said alcohol-related hospitalizations in B.C. have been steadily rising over the past decade, and are getting close to the number caused by tobacco.
He said the increase is being seen across the entire population regardless of age and gender, but there are some marked geographical differences.
"The North has the highest rates of deaths as well as hospitalizations from alcohol, whereas the Interior comes about second, Vancouver Island third — all of them are above average," he said.
"And below average is Vancouver … and the Fraser [Valley] area."
The numbers are no surprise to provincial health officer Dr. Perry Kendall.
"There are a large number of diseases and illnesses that can be linked to dangerous alcohol consumption," he said. "We know that one of the most effective means of lowering alcohol consumption is actually pricing."
Stockwell agrees the most effective way to curb drinking is to make alcohol more expensive.
"The Ministry of Solicitor General and Public Safety have the power to set minimum prices already — the fact is they don't," he said.
"We're very familiar with alcohol and we take it for granted. It's not like milk and orange juice, and so we've got to look at rather different responses because it's not just an ordinary commodity."
Addiction and the Brain - drug or alcohol abuse is a disease.
A new chapter begins Monday in the ongoing legal battle over British Columbia’s impaired driving laws.
The case at the B.C. Court of Appeals alleges that the impaired driving law is unconstitutional because it violates the charter rights of those who fail (or refuse to take) a field sobriety test by denying them a presumption of innocence.
“If the government wants to revise the way that it goes about drinking and driving, that’s fine,” Raji Magnat, a lawyer with the B.C. Civil Liberties Association (BCCLA), told Global News. “But it doesn’t do anyone any good to have laws in place that are not providing constitutional protection to citizens.”
“Our focus remains on public safety and reducing the number of alcohol-related driving fatalities and injuries on B.C.’s roads,” B.C. Justice Minister Shirley Bond told Global News. “With 104 lives saved in the past two years and a 46 per cent reduction in alcohol-related fatalities since our law came into force , it’s clear we’re doing just that.”
At the heart of the controversy is the province’s Immediate Roadside Probation, or IRP, program. The new law allows a police officer to issue a variety of penalties if, during a field sobriety test, the subject shows higher than 0.08 blood alcohol content (BAC) on an approved screening device (ASD), or refuses to conduct a field sobriety test.
Those who do face an immediate 90-day driving ban, a $500 fine, and will have their vehicle impounded for 30 days. In addition, drivers will be required to participate in the provincial Responsible Driver Program. They must also use an ignition interlock device, which tests a driver’s breath for alcohol every time they operate their vehicle, for up to one year.
According to the BCCLA, this violates a citizen’s charter right to the presumption of innocence until proven guilty.
“The way the legislation has been crafted has created a criminal regime without procedural or due process protections in place,” Mangat said. “We feel this is significant given the significant penalties that this law entails.”
On Nov. 30, 2011, B.C.’s Supreme Court ruled that the new law violated the Charter of Rights and Freedoms. While agreeing that the law as a whole did not violate a citizen’s charter rights, the court ruled that the IRP program was unconstitutional, because it imposed significant penalties on a citizen without the ability for those found guilty to meaningfully challenge the decision.
So the province amended the law in 2012, allowing for the right to a second field sobriety test with a different ASD, as well as mandating that police inform citizens of this right. The amended law has been in effect since June 15, 2012.
“The procedural changes for police – including advising drivers of the right to a second test on a second approved screening device – and the complementary changes strengthening the appeal process help to ensure a consistent, fair approach,” Bond said.
Addiction is an equal opportunity disease. It can affect the educated, the uneducated, the rich as well as the poor. What is certain is that it destroys families and society if left untreated.
Everyone has their own understanding of this terrible condition that can affect up to 15 per cent of the population. Loved ones and addicts themselves often frame it as moral failure or weakness because despite multiple apologies and promises to do better, the addict continues to relapse with the associated secrecy, lying, stealing, shame and guilt. Few look at the scientific advances to better understand this brain disease that robs individuals of their ability to resist the behaviour be it alcohol, tobacco, illicit drugs or gambling. The consequence is the deterioration of the addicted person physically, psychologically and morally, and not the other way around as is commonly understood.
Current research identifies at least three brain circuits involved in the addictive process. These circuits mediate reward and pain, appetite, learning and memory. In the addicted brain, it is thought the activation of these circuits override the self control circuits despite the best intentions not to use. In other words, the brain has been hijacked and the person loses control. What underlies this is the genetic risk interacting with social, economic and environmental factors to cause the brain to malfunction.
These phenomena have been incorporated into the definition of addiction as a chronic relapsing brain disorder by the American Society of Addiction Medicine and the symptoms include cravings and withdrawal with observable consequences such as loss of control and continued substance use despite negative consequences to self or others. These have been codified into criteria in DSM 5, the psychiatric diagnostic tool, to facilitate reliable diagnosis.
It should be noted that the legal status of the drug doesn’t necessarily correlate with the harm caused. Alcohol and tobacco are addictive, can cause as much or worse damage and are often harder to quit than some illicit drugs. Consequences of heavy alcohol use, for instance, range from cirrhosis to many kinds of cancer, and socially from drunk driving to increased violence.
Addiction is more about the maladaptive pattern of behaviour than the drug itself, or the amount used per se. Therefore, urine drug tests cannot diagnose addiction, only confirm use of an addictive drug. And most people fail to recognize their addiction because the social norms of “getting wasted” or high is tolerated in their home, social and work environment.
The tragedy is that despite addictions being treatable with a combination of medications and behavioural counselling, the stigma associated with this disorder leaves many people relying heavily on will power alone to get better. Curiously, the very organ, the brain, that will need to be engaged in the recovery process is compromised by the addiction itself. Therefore, the most important first step for friends and families is to address the denial and refrain from any action that perpetuates the addictive behaviour. This is how the motivation to change can be kick-started facilitating the true appreciation of the consequences of the addictive behavior by the addict. Ideally this leads to self-realization. It can be facilitated by work places, colleagues, friends, bosses and family members reflecting concern to the addicted person or holding the addict accountable for their actions. Patients will often tell us that prior to seeking help, it was the intervention by others that got them to realize the impact of the addiction. Many people are afraid to speak up due to fear of damaging their relationship and not knowing what to say. However, if done with compassion combined with clarity and firmness the relationship is not likely to be harmed. In fact, the expressed concern might just motivate the person to make a change.
Relapses are common and therefore the goal of treatment is to help the person stop, stay stopped and ensure that relapses are treated swiftly should they occur. With the right support and care, people with addictions can become fully themselves, as well as fully productive members of society.
Dr. Peter Selby is chief of addictions at the Centre for Addiction and Mental Health (CAMH).
Specific procedures for assessing clients in substance abuse treatment and family therapy will vary from program to program and practitioner to practitioner. However, an overview of these activities is useful.
Assessment in substance abuse treatment
Assessments for substance abuse treatment programs focus on substance use and history. Figure 3‐1 presents an overview of some of the key elements that are examined when assessing a client’s substance abuse history—including important related concerns such as family relations, sexual history, and mental health.
Figure 3-1 Overview of Key Elements for Inclusion in Assessment
Standard Medical History and Physical Exam, With Particular Attention to the Presence of Any of the Following
Physical signs or complaints (e.g., nicotine stains, dilated or constricted pupils, needle track marks, unsteady gait, tattoos that designate gang affiliation, “nodding off”)
Neurological signs or symptoms (e.g., blackouts or other periods of memory loss, insomnia or other sleep disturbances, tremors)
Emotional or communicative difficulties (e.g., slurred, incoherent, or too rapid speech; agitation; difficulty following conversation or sticking to the point)
Skinner Trauma History
Since your 18th birthday, have you
Had any fractures or dislocations to your bones or joints?
Been injured in a road traffic accident?
Injured your head?
Been injured in an assault or fight (excluding injuries during sports)?
Been injured after drinking? Source: Skinner et al. 1984.
Alcohol and Drug Use History
Use of alcohol and drugs (begin with legal drugs first)
Mode of use with drugs (e.g., smoking, snorting, inhaling, chewing, injecting)
Quantity used
Frequency of use
Pattern of use: date of last drink or drug used, duration of sobriety, longest abstinence from substance of choice (when did it end?)
Alcohol/drug combinations used
Legal complications or consequences of drug use (selling, trafficking)
Craving (as manifested in dreams, thoughts, desires)
Family/Social History
Marital/cohabiting status
Legal status (minor, in custody, immigration status)
Alcohol or drug use by parents, siblings, relatives, children, spouse/partner (probe for type of alcohol or drug use by family members since this is frequently an important problem indicator: “Would you say they had a drinking problem? Can you tell me something about it?”)
Alienation from family
Alcohol or drug use by friends
Domestic violence history, child abuse, battering (many survivors and perpetrators of violence abuse drugs and alcohol)
Other abuse history (physical, emotional, verbal, sexual)
Educational level
Occupation/work history (probe for sources of financial support that may be linked to addiction or drug‐related activities such as participation in commercial sex industry)
Interruptions in work or school history (ask for explanation)
Arrest/citation history (e.g., DUI [driving under the influence], legal infractions, incarceration, probation)
Sexual History: Sample Questions and Considerations
Sexual orientation/preference—“Are your sexual partners of the same sex? Opposite sex? Both?”
Number of relationships—“How many sex partners have you had within the past 6 months? Year?”
Types of sexual activity engaged in; problems with interest, performance, or satisfaction—“Do you have any problems feeling sexually excited? Achieving orgasm? Are you worried about your sexual functioning? Your ability to function as a spouse or partner? Do you think drugs or alcohol are affecting your sex life?” (A variety of drugs may be used or abused in efforts to improve sexual performance and increase sexual satisfaction; likewise, prescription and illicit drug use and alcohol use can diminish libido, sexual performance, and achievement of orgasm.)
Whether the patient practices safe sex (research indicates that substance abuse is linked with unsafe sexual practices and exposure to HIV).
Women’s reproductive health history/pregnancy outcomes (in addition to obtaining information, this item offers an opportunity to provide some counseling about the effects of alcohol and drugs on fetal and maternal health).
Mental Health History: Sample Questions and Considerations
Mood disorders—“Have you ever felt depressed or anxious or suffered from panic attacks? How long did these feelings last? Does anyone else in your family experience similar problems?” (If yes, do they receive medication for it?)
Other mental disorders—“Have you ever been treated by a psychiatrist, psychologist, or other mental health professional? Has anyone in your family been treated? Can you tell me what they were treated for? Were they given medication?”
Self‐destructive or suicidal thoughts or actions—“Have you ever thought about committing suicide?” (If yes: “Have you ever made an attempt to kill yourself? Have you been thinking about suicide recently? Do you have a plan?” [If yes, “What means would you use?”] Depending on the patient’s response and the clinician’s judgment, a mental health assessment tool such as the Beck Depression Inventory or the Beck Hopelessness Scale may be used to obtain additional information, or the clinician may opt to implement his own predefined procedures for addressing potentially serious mental health issues.)
