Breaking Patterns: Systems Impact on Addiction

This episode was pre recorded as part of a live continuing education webinar on demand. CEUs are still available for this presentation through all CEUs. Register@allceus.com Counselortoolbox you I'd like to welcome everybody to today's presentation on the system's influences on mood and addictive disorders. This is kind of a continuation of what we were talking about yesterday with a little bit of history thrown in to give it some, give it some depth if you will. We're going to examine the prevalence of mood and addictive disorders and learn about the history of addictive disorders behaviors in the US and then we'll look at some systems influences, political, economic, yada yada. Some of those exosystems that we talked about we didn't really get to yesterday in the development and maintenance of addictive and mood behaviors or mood disorders. So I will say for your test, for your quiz, I don't quiz on specific statistics. So this thing like 32% lifetime prevalence of anxiety, it's important to just kind of have that hit you and think, you know, one out of every three people will experience a clinically diagnosable episode of anxiety in their lifetime. At any point in time, any 12 month snapshot, roughly one out of every five people, you know, look around the room, wherever you're at, whether you're in the grocery store or at church or in a staff meeting, roughly one out of every five of those people, people meets criteria for an anxiety disorder. And only 13% of those people who have one, you know, so one out of five are experiencing it, but only 13% of the people who need treatment are getting it. Oh, that just kills me. Depression has a lower prevalence and we're really looking at just major depressive disorder, not persistent depression, what used to be called dysthymia in the DSM 4, but that's 7%. So that's still a relatively high number. That means one out of every 13 people is experiencing a depressive, experiences a depressive episode at least one in a 12 month period. That's significant. I mean, we're not talking just the blues. We're talking clinically diagnosable major depressive disorder. The prevalence among people with depression is significantly higher among people of two or more races. So that goes, you know, from a clinician standpoint. I'm going to look at that and I'm going to say we are not doing well as a society, as a culture, maybe on being culturally sensitive. So we kind of want to look at that. And there's Also the process of acculturation and all that stuff we go over in cultural diversity. But it's important to understand that people who are of multiple races have a higher risk, it appears, of experiencing clinical depression in any 12 month period. Now I have the resources over here. If you want to go look up the statistics, you can certainly do that. But again, you won't be tested on the exact numbers. Alcoholism 6% 12 month prevalence and 6% of that 6% receive treatment. So we think of alcoholism as probably being a more common addiction than it really is because 12 step programs are so prevalent around. But actually, I mean, we're looking at alcoholism and clinical depression are roughly at the same rate now. Is that good? Of course not. Sex and pornography addiction 3 to 5% of the population struggle in any year with compulsive sexual behaviors. So I put sex and pornography together because they haven't really split those out in the literature. And it's a new field. But it's important to understand from a clinician standpoint. Our clients that we're seeing for mental health issues may also have some alcohol issues, maybe alcohol abuse, maybe not quite dependent yet, or misuse. And they may not recognize a pornography addiction. Sex addiction is a little bit easier to recognize because you actually have to go out and get it and, or engage in other behaviors. But pornography addiction, that's sitting at home on your, on your Internet or at work on the Internet, in the car, driving on the Internet. Yeah, it can be. It's everywhere and it's endless. So there's a high rate of sex and pornography addiction. And we're good. You know, if you think back to yesterday and we'll talk a little bit about the fact that the changes, the brain changes that occur during a addictive episode when somebody engages in some addictive pleasurable behavior for flooded with dopamine. So then the brain says, I can't be this happy for this long, so I am not going to be quite as sensitive. I am not going to let quite as much dopamine go through. So on the normal days, the person is kind of jonesing for a rush because they don't even feel, they don't feel as happy after a while because they need that extra push. You know, if you're somebody who's consumed a lot of caffeine for a long time, you, you might be able to kind of relate where you get up and you just. Your body doesn't even hardly get started without having caffeine in your system because it got so used to having that Artificial energy and drug abuse. 27% of Americans reported using illicit drugs in their lifetime and 3% of Americans over 12 reported in a 12 month period over the age of 12 reported non medical use of prescription drugs. So I mean we're talk, we're not just talking opiates, we're talking sleep aids, you know, lunesta, any of your benzos or barbiturates, you know, any of those things that you get prescribed by a doctor. 3% of Americans over the age of 12, oh my gosh. Report non medical use in a 12 month period. And it is really popular among unfortunately a lot of teenagers and youth to go into their parents medicine cabinets and just kind of grab whatever they can and they put it all into a bowl and just kind of guess and take a handful of pills, which is like playing Russian roulette. But that's a whole different, whole different class. So understanding that mental health issues and substance abuse issues are really prevalent out there and there's a lot we can do to try to prevent them, but there's also a lot we need to do to reach out and provide early intervention and bring people in and let them realize that, you know, this is having a safe, significant impact. But a lot of what we're going to talk about today deals with prevention. Let's look at some of these systems and see where we might be able to, you know, step in themes to look for when we talk about history. And I'm going to go through history really quick because it's just a little brief history lesson. But I want you to look for the fact that a lot of times the problems with substances initiated from the medical, medical community trying to treat something and the more people that were treated, the more available the drug became, the more available the drug became, the more was out there for diversion. So I mean, think about 15, 20 years ago when you used to go have your wisdom teeth out or something. A minor procedure. You might get two weeks worth of opiates for pain management. Now the doctor's probably going to give you three days if he gives you any. But so people were getting this and they were having opiates left over if they weren't taking them the whole time so they could sell them or they were more available or they took them and they're like, ooh, this produces an awesome feeling. I'm going to keep taking these as long as I can get them. And suddenly they're calling their doctor back and going, I need more economic motivations. We want to look at what in the Economy might be contributing to the increased availability of drugs and alcohol, the increased positive promotion in media. You know, why is this problem there? We want to look for giving into political pressures to repeal. And one thing you'll find is pretty much every time they put a law into place to prohibit something, it doesn't work. People who want it will get it. If they want it bad enough, they're going to get it. It doesn't cease use for anything. And people who don't want to go through all the trouble just find something else. So a lot of times the drug prohibition laws don't work. And politicians who want to get elected think back to the recent elections when we did a lot of voting on legalizing marijuana. A lot of politicians will go with whatever their constituency is wanting because they want to get reelected. Where there's a will, there's a way or an alternative. So, you know, when one is less available or too expensive, they'll find something else. And that's just human nature. If we're using it for relief, if we're using it for relaxation, and we want to look at cheaper alternatives because most of these drugs end up becoming available in cheaper forms or cheaper alternatives come up. So cannabis, marijuana was first introduced to the US in 1545. So a long, long time ago, in 1775, the hemp culture was introduced into Kentucky, and large hemp plantations flourished in many states until well into the 1800s. So this was an economic business. Farmers were making money from it, consumers were buying it. Everybody was happy. Until the late 1800s, tobacco, alcohol and opium could be purchased readily, free from government controls, and were quite fashionable to use. So again, you've got social pressures as well, or social thoughts that this is an okay thing to take. There's no government controls making it difficult to get, and in many cases, it was relatively affordable. During the Civil War, blockades on southern ports curtailed the imports of tea and coffee. So people switched over to a drink made from the cassia leaf, which has psychogenic properties, and this drink became a viable alternative to coffee and tea. So we had people becoming addicted to a different drug because they couldn't get the caffeine. Morphine was used commonly as a painkiller during the Civil War. So a lot of soldiers became addicted to, like I said yesterday, three to five days, people start building up a tolerance to opiate drugs. And morphine is a pretty powerful opiate. So you had a lot of people and they didn't think that opiate drugs were addictive back then. So you had a Lot of soldiers that were in the hospital for a week, two weeks or more, and they were getting addicted to opiate type medications. In the late 1800s, to add insult to injury, morphine, an opiate, was prescribed as a substitute for alcohol addiction. So people who were addicted to alcohol were actually given opiates to help them get off of it. So we've got another reason that opiates are starting to come into the market. And yeah, I'm sure the people who were addicted to alcohol were feeling better. We know that when people are detoxing from alcohol, their blood pressure goes up. That's one of the primary side effects. And opiates are depressants. They're going to lower respiration, lower heart rate. So there's a relationship. We can see here where it probably did help. I mean, right now we look at more at benzos during the detox period. But opiates were used in the 1800s because benzos didn't exist yet. In 1844, cocaine was first isolated from the coca leaves. Woo hoo. And this doctor in Germany issued a supply of pure cocaine to soldiers to increase their endurance and alertness. And it worked. And they said, this is really good. So it became a common practice to give soldiers cocaine to help them stay alert. In 1885, a guy named John Stith Pemberton of Atlanta, Georgia, came up with Coca Cola. So he combined cocaine, which is a stimulant, with caffeine, which is a stimulant. And you know, we, one plus one is like six. And they came up with this drink of Coca Cola that a lot of people really liked. And unfortunately, because of the, well, because of the cocaine, but also a little bit because of the caffeine, was highly addictive. From 1850 until 1942, marijuana was recognized as a legitimate medicine under the name of extractum cannabis. So we still see, even from 1500 all the way through 1942, cannabis is relatively legal and has some uses. So we see that there are medicinal properties to it. And we're going to look as we go through why suddenly, suddenly society decided it was this scourge. In 1898, the Bayer Corporation, you know, Bayer aspirin, found heroin as the newest opium derivative. And it was widely advertised as being at least 10 times as potent a painkiller as morphine with none of the addicting properties. Oh, boy. So now we have this new, more powerful thing coming on. And the people who found relief in morphine found a lot more relief in heroin. In 1920, the Prohibition act was passed. This is for alcohol was repealed in 1933. Again, politics. It was not a popular thing. People wanted their alcohol. It didn't prevent anything. There were economics of it because the government was losing money on taxation and people who sold alcohol were losing money on it, unless they were making stills and moonshine. And it was relatively, at that point in time, just unenforceable. They found that it was just overwhelming to try to enforce it. So they just said, you know what? We're going to scrap it. In 1925, the import of opium for the manufacture of heroin was finally banned in this country. So alcohol is banned in 1920, opium is banned in 1925. Alcohol comes back in 1933, but there's still some restrictions on opium. Throughout the 19th century, opium and marijuana users enjoyed their diversion with little harassment. So it wasn't until the 1900s that they started saying, well, this might be a problem. The Federal Harrison Narcotic act was passed in 1914 in order to provide for a register and impose a special tax upon all persons who produced, imported, manufactured, compounded, dealt, dispensed, and sold, distributed or gave away opium or cocoa leaves, their salts, derivatives or preparations. The government now wanted their chunk of change. In 1918, three years after the Harrison act went into effect, a study by a congressional committee released the findings that opium and other narcotics, including cocaine, were being used by about a million people still. So where there's a will, there's a way. The underground traffic in narcotic drugs was about equal to the legitimate medical traffic. So. So even if it had legitimate medicinal uses, there was also this whole underground community and economy that was flourishing off of it. The dope peddlers appeared to have established national organizations, smuggling the drugs in through seaports or across the Canadian or Mexican borders. So these aren't ones that were making or growing in the US Right now or back then, and I guess even now, but they were getting into the country. The wrongful use of necrotic drugs had increased since the passage of the Harrison Act. So they passed this act for taxation. And so people just went underground, and there was even less ability to kind of control it because it wasn't being prescribed anymore. It was, you know, black market stuff. By 1913, District of Columbia and 46 states had adopted some form of legislation against marijuana. So, you know, we have people starting to get really concerned about drugs and alcohol's back. So there's not as much of a need for marijuana. You know, it's really unclear as to why people got so fired up about marijuana. When these other drugs were still legal or being or readily available, the Treasury Department officials submitted to Congress a proposal which was eventually passed as the Marijuana Tax Act. Again, government going, if you're going to use it, we get paid. The act didn't actually ban marijuana at all, but like the Harrison act, it recognized the potential medical uses of the substance. Okay, we'll give them the benefit there. But imposed a tax on those involved in the distribution. So we've got marijuana that's still being used medicinally at this point. In 1938, LSD was discovered. They're like, oh, score. This is a new one. The use of cocaine declined in the 1940s due to the lack of availability. So there was some cracking down. It wasn't no, no pun intended on the cocaine coming across the borders, but the LSD, this was something that was available in the US from 1938 to 1958. LSD was used to treat a variety of medical and psychological issues, issues including psychosis, pain management and anxiety, what they called neuroses back then. So again, the doctors are going, this is a cool new drug. Let's throw it at everything and see what sticks. In 1960, fentanyl was first synthesized by Janssen Pharmaceuticals. And obviously I'm going chronologically, not by drug because I kind of want to see, want you to see the ebb and flow of different drugs that are available. In 1962, LSD could be purchased legally by physicians, psychiatrists, psychologists and other mental health professionals who could certify a legitimate use for the substances. Oh, you can see a issue there. You can see people, you know, finding legitimate uses, creating an economy for themselves. In 1965, regulations were passed that outlawed LSD. But the formula to make it could still be purchased from the patent office for 50 cents. And the ingredients were easily acquired. So just like what we're going to end up talking about with bathtub methamphetamine, people learned that they could make it pretty easily and cheaply in the United States. At home, they didn't have to worry about importing. So they're like, well, I'm going to keep doing this. Doctors Timothy Leary and Richard Alpert, instructors at Harvard, spread the word about LSD to anyone who would listen to. There was a revolution about to start. The mind would at last be freed from the bondage of proletarian concerns. So, you know, this is, we're in the 60s here, you know, you know what the culture was like back then. So people are really latching onto this. Cocaine regained popularity in the 1970s and 80s, though glamorized by the media as a non addictive recreational drug. So they don't realize the addictive potential of cocaine. In the 70s and 80s, the media glamorizes it. If you look at movies from the 80s and, you know, I grew up in the, in the 70s and 80s, people were, there was a lot of media portrayal of people at parties doing lines of cocaine. So it was sort of the thing to do back then. So it gained more popularity, but it was still expensive because they were having to import it. So in 1985, crack emerged as an affordable alternative to pure powder cocaine. Crack is cocaine plus baking soda. Basically the increase in opiate prescriptions in 1980. So crack is emerging. This is, you know, they still have to get the cocaine, still have to make it, but it, it's pretty readily available and crack is relatively easily manufactured. Once you get the cocaine in the, in the United States, then we start with the problem of opiates. And opiates really didn't flare up again. You know, there was the initial flare back when they were using it in the war and everything. But it started to flare again in 1980 when an 11 line letter, 11 lines printed in the New England Journal of Medicine in January of 1980, pushed back on the popular thought that using opioids to treat chronic pain was risky. This letter and a couple of studies, not a bunch, created after a discussion in the 1990s, making pain treatment a priority for all patients. So now they're saying opiates really are not addictive for people with chronic pain. There's not a great risk of problems from it and people's quality of life because of chronic pain is poor. So we really need to look at pain treatment. In 1998, Purdue Pharma created a video promotion called I Got My Life back. It followed six people with chronic pain who took OxyContin and basically looked at how much their life had improved since they had started using oxycontin regularly. This was promoted. You know, it was a video. It was also on commercials. You know, people were starting to see it on TV. In 2001, the Joint Commission for the Accreditation of Healthcare Organizations, or jaco, made pain assessment of all patients a requirement. I remember when this happened, we had to change all our manuals. So now, and one person in the articles I was reading said asking people about pain or pain management became as common as checking people's vital signs, because we had to check it assessment and we had to check it at every reassessment. So Jaco is having us kind of ask people, do you have pain? Let's see what we can do to help you with your pain, to increase your quality of life. So there's a real push here. And if you're conspiracy minded, you might think that there's some underlying support from the drug companies going, we need to start asking people about chronic pain in order to make sure that we were really kind of pushing this issue. They started to realize it was a problem, though. They started to realize there was some abuse issues in, you know, 2005 up to 2010. So OxyContin was blended with an abuse deterrent, which is Tylenol. So what did the users do? They switched opiates. They're like, no, okay, fine, I'm not going to take that one. I will take one that won't ruin my liver, may just ruin my life. In 2015, trials began to treat resistant depression with opiates. So we're still, even though we realize that there is a significant problem with opiates, there's a significant opiate epidemic right now. We haven't learned our lesson, it seems we're still throwing it or trying it with new to treat new disorders, if you will try trying it to treat in novel ways. And I think a lot of that is spurred on editorial. I think a lot of that is spurred on by the pharmaceutical companies wanting to continue to make money. However, fentanyl patches. I found this terribly interesting and concerning fentanyl patches are in the World Health Organization's list of essential medicines, the list of the most effective and safe medications that every country needs to have. I was just like, wow, that is kind of scary because fentanyl is like 50 times more powerful than heroin. So we're looking at things that are really intense and they come in patches and lollipops and other things. So you can see that there's an ebb and flow when people can't get. If people couldn't get opiates, you know, because they're trying to do a lot of legislation to keep doctors from prescribing it and yada yada. Well, you know what? Until we figure out what's causing people to want to use opiates and what the benefit is and provide them a different alternative, they're gonna find something else. Unfortunately, it's, it's not as simple as just removing it. The history of cigarettes. Now, I put this in a little bit. No, differently. There was an explosive increase in cigarette smoking after 1910, which can be attributed in part to the public health campaigns of that era against chewing tobacco, they were telling people that the sputum of tobacco chewers spreads tuberculosis and other diseases. So people were like, oh well, I'm not gonna, I'm not gonna dip, I'll smoke instead. By 1921, the year after alcohol prohibition, 14 states had laws prohibiting cigarettes and a bunch of anti cigarette bills were under consideration. But people continued to smoke and the last statewide cigarette prohibition law was repealed in 1927. I watched the Beverly Hillbillies and regularly there are, if you watch the old ones, they'll have the ads that are attached, still attached to the episode. And Winston Cigarettes was a prominent sponsor of the Beverly Hillbillies. So you see that periodically and it just kind of makes me cringe. Now the government currently earns around 15 billion. That's 15 billion with a B dollars in revenue from cigarette taxes each year. So you do the math and figure out where the motivations lie. So looking at the history, we can see that there's a long history of drugs being used. We don't have data to show back to, you know, I was trying to look for back to the Great Depression when there might have been a lot of mood disorders. What was the frequency of mood disorders during the Great Depression? What was the frequency of alcoholism? And there's just really, there's no data, at least not that I could find that's available to tell it. So we could compare, you know, back then to now and see if anything's changed so we could start trying to intervene there. So my question is what current social and cultural influences do you see that you think contribute to the development of mood disorders, you know, depression, anxiety and, or addiction? And I kept it kind of close with mood disorders instead of saying any mental health issues because we know there's a large genetic component, if you will, or a biological component with schizophrenia and some other disorders like that. So we're really looking at anxiety, depression, things that are less tied to genes. So let's, you know, start looking and if you think of some more, feel free to chime in. Social systems influence on mental health and substance abuse. MH is mental health and SA is substance abuse. Coping methods that we model, you know, as Americans, how do we model coping to our children? How do we model coping to each other right now? Think about the media, think about how people deal with adversity, deal with conflict. Is this a model that is going to promote mental health and compassion and you know, everybody holding hands and singing Kumbaya or is it going to promote anxiety Anger and depression I tend to lead towards. We've got a lot of ineffective coping mechanisms right now. Substance use, aggression, those things seem to be pretty prominent also. Just ignoring it, avoiding it, burying your head in the sand and going, you know, la la la la la. Not helpful. It doesn't solve the problem, it just gets you away from it for a moment or maybe changes it. Patterns of use that are modeled. So when we're looking at the social system's influence on substance abuse and you know, I want to say addiction in general, whether it's gambling, Internet porn, sex addiction, you know, any of those things, what's being used, you know, what are the common popular things right now you remember right after Tiger woods went in for sex addiction treatment, you know, all of a sudden other people started following suit. So there was some social pressure maybe to acknowledge and identify it or maybe it was the in thing to have, you know, I don't know what the celebrities motivations were, but we want to look at, you know, what types of substances or activities does our culture, does our social system say this will help you feel better? When is it used? You know, if you think about food, for example, in American culture, we eat all the time. We eat. When we're hungry, we eat. You know, we go out to meetings, we'll take clients to lunch or dinner, we eat during celebrations, we eat during holidays, we eat during funerals, we eat. So then think about drinking alcohol. You drink at those dinners with clients, you drink at celebrations, you drink at parties, you drink while you're watching football on the television. And you know, obviously that's not true for everybody, but these are common times when people engage in alcoholic behavior. You can say the same thing about smoking and other legally or socially sanctioned drugs that we're talking about. And why is it used? What's the benefit? Are people using to escape? Are they using to fit in with a peer group? Are they using just because it's what they've always done? Peer pressure and acceptance of health related behaviors or treatment seeking also influences mental health and substance abuse. Back in my grandmother's day, you know, going to a therapist for depression treatment was a no, no, you know, you didn't air your dirty laundry, you dealt with it, you sucked it up. When I was younger, I think it was still a little bit taboo. Sometime in the 90s, I think it became the fashionable thing to do was to have a therapist. So people were more accepting, I guess of seeking treatment for mental health issues and substance use disorders and health related behaviors. You know, when in the 60s when everybody was taking all kinds of drugs, you know, there wasn't a problem with it. People didn't see a problem with it. When in the 80s when people were doing lines of cocaine, you know, it, that was one of those socially sanctioned things. Now people seem to have gone a little bit more. It seems to be a larger proportion of the population that tends to be in thinking about health related behaviors and exercising and eating well and getting rid of gluten and all that other kind of stuff. So we want to look at how do social systems influence whether people take care of themselves and get treatment when needed and the availability and engagement in health positive or health negative behaviors. So what options are there? You know, when I lived in Virginia a couple years ago, the town I lived in had one gym. It was a relatively big town. It just exercise didn't seem to be a real priority right there. So it was a little bit harder to find places to go work out and people who enjoyed working out like I did, finding places where there are people. The social systems that promote health, positive behaviors, healthy eating, healthy exercise, relaxation, you know, not just, you know, kind of working at it all the time, but actually letting your hair down and having fun versus places where there's a lot of negative health behaviors. There's a proliferation of drug use and obesity and people, you know, kind of sitting on the couch think about and places where it gets wicked wicked cold. And you know, for me, wicked cold is anything below about 35, you know, social systems. There's not a lot of people that like to go out and go hiking or engage in a lot of activities when it is really cold outside. So. And a lot of people aren't going to do it by themselves. So there could be more health negative behaviors in during certain times of the year where people are just like, nah, I think I'm going to sit inside, drink cocoa and just cover everything up with a big sweater. So social systems have a big influence who we hang out with, what they do, because we tend to want to be affiliated and we tend to want to spend time with people. Political systems also influence both mental health and substance abuse laws regulating medication and treatment availability. It takes so many years for drugs to get through the FDA that you know, there are a lot of antidepressants, anti anxiety medications that may be in the works that won't come out for another five or ten years right now. So that can have an influence if there is a good drug. Now on the other side, it keeps harmful drugs, fewer harmful drugs from actually making it through all the trials. Another law if you will. When I worked in Florida for counselors, we couldn't bill for case management for a lot of things. And I'm sorry. We do a lot of, or at least where I was and I still do a lot of case management, making referrals, following up, doing all that stuff. And they weren't billable hours. So it was harder for us to spend a lot of time making sure that our clients had all the wraparound services they needed to deal with their depression, anxiety or addiction. Access to social service programs for health care, medicine and food. Think of Maslow, you know that bottom tier, you have to have the building blocks to make the neurotransmitters safe housing and you have to be relatively healthy. If you are sick or in chronic pain, it's going to be hard to work on having a really good mood or you know, dealing with improving your self esteem. Changes in the political system can also enhance a feeling of disempowerment and oppression. Enough said. That's obvious. And laws regulating access to addictive substances and behaviors such as gambling and pornography can also have an effect. Just like we talked about, when things become more difficult to get, you know, when opium became more difficult to get, people kind of switched to something else. Fentanyl, as a side note, I didn't mention it back then, is much, much, much, much cheaper to manufacture than heroin. So fentanyl became an affordable alternative to pure heroin. And it actually can be manufactured. It's not easy, but it can be manufactured in the states. So if there were laws regulating gambling, you know, it might control it a little bit. Laws regulating child pornography are extremely strong. And that's not all pornography, just cp. But it does reduce the number of people who are thinking, you know, maybe I'll just go here and check it out. They don't even want to go there because they don't want to risk the penalties. So there are ways to deter people. It's not going to prevent everything, but it can deter. Repeal of laws is the result of pitocal political pressure from constituents also you know, influences how people feel about things. What substances are available, taxes on substance. And you know, when we talk about repeal of laws, think about the Affordable Care act, you know, how is that going to affect people's ability to access mental health care when they need it? Especially if their mental health issue was a pre existing condition. Taxes on substances. Obviously the government wants to keep itself going and it needs to figure out how to fund itself because they're always in Debt. So taxes on these activities brings in a lot of money to the government. So they're motivated to not make it go away, just to try to control it a little bit. Laws regulating marketing practices of addicted substances and mental health medications also influence mental health and substance abuse. I mean, right now, you know, there's not a lot of laws that prohibit advertising these things on tv, especially like mental health medications. I have watched countless pharmaceutical company commercials and you hear about this drug and how wonderful it'll make your life and everything. And when the commercial's over, I'm like, well, what was it supposed to treat? But there's such a promotion about how much better life will be. So there's not a lot of real strict laws on presenting the information about the actual effectiveness in clinical trials of, you know, whether this worked. You know, we know that if it got through the fda, it probably didn't hurt anybody. But how many people actually saw significant clinical improvement and enhanced training and penalties for servers? I mean, this is an alcohol thing, obviously, but it's one of those laws that the government and political systems can put down because you've got people who own bars, they're not going to sell their bars. There's too much of an economic motivation. So in order to control the consumption without having to get rid of it because they like their taxes, they put more regulations on the sale of alcohol, economic systems, availability of addictive behaviors, the Internet, if you are addicted to pornography, if you are addicted to shopping, and I know people who have, you know, they'll go online and they can blow $30,000 without thinking twice about it. And you know, and then they're like, that was how they were escaping. There's an endless supply of places to shop online. But in your community, if there's a huge availability, whether it's street level drug dealers or corner stores, or there's a lot of shopping where you live, or whatever it happens to be, people may be more likely to engage in addictive behavior if it's easily accessed. Remembering that addictive behaviors mucks up the neurotransmitters and can cause depressive symptoms. Now, is it intractable? No. Once the brain balances out, the mood disorder generally goes away if it was caused by the substance, but it can cause depressive or anxiety related symptoms. Affordability, the upsurges of fentanyl free porn and bathtub meth have all increased the use of those things. And now if you want just standard porn, evidently there are several sites that you can just access it for free. So people are accessing it, and youth unfortunately are accessing it earlier. Cigarette cost and taxes. You know, when we look at cigarette use, cigarette use has gone down because there has been, I mean, they're really expensive now and the cigarette taxes are really high. So people are not using it quite as much. They're turning to vaping and you know, in some cases they may be turning to marijuana. I don't know what the cost comparison is there, but so use is reduced some, but it's not eliminated. And the affordability of medication and this can be your antidepressants or any of your medication that you're prescribed. If people can't afford it and they need it and it actually would help them feel better and they can't get it, then they're going to continue to have, you know, suffer with symptoms. Remember that most pharmaceutical companies have patient assistance programs and there are formularies at most grocery stores and Walmarts and stuff that have like the $5 prescriptions for a lot of the necessary medications. And a lot of times doctors can be cajoled by the patient to prescribe a medication that's on one of those lists instead of some, you know, name brand only medication. Motivation of Big Pharma to convince people to buy more drugs increases people's presentation for substances, whether it's opiates or antidepressants. People are looking for happiness in a pill and Big Pharma seems to promise that. Then when they take a pill and they don't automatically get happy, then they can start feeling depressed and anxious and like, what's wrong with me? Am I never going to get better? And actually sort of create a situation where they don't feel well. The ability of taxation of a substance or activity to benefit the government is another economic pressure. So we want to look at what are, what's the government getting out of it. Whether it's, you know, Xanax or something that's like marijuana. The availability of health and mental health care and the availability of nutritious foods, we'll just kind of put those together. People need to be able to afford the stuff that gets that bottom level of Maslow's hierarchy taken care of. So is it available and affordable? Can they, you know, with insurance deductibles the way they are right now, I know a lot of people who have insurance that can't afford to go to the doctor because they pay so much in deductibles. Their deductible is so big that they pay 100% of the office visit pretty much unless they go to the hospital, so they can't even afford medical care, even though they have insurance. So we want to make look at it and see, is this even working? Do people have access to affordable health care? Can they afford nutritious foods? A lot of the cheapest foods are some of the unhealthiest foods, but that's a whole different soapbox for me to get on. For us, what can we do? We can help patients make sure that they know about how to access patient assistance programs for medications. We can educate patients about the effectiveness of medications in treating their disorder, help them make educated decisions. We can educate them about the effects of different addictive behaviors and help them see the difference between social or recreational use and addiction, which is when it starts causing clinically significant problems, and they continue to do it anyway. Cultural systems, you know, this is, you know, really looking at the big macro concepts or meta concepts, the acceptability of media portrayals. We spend a lot of time watching videos and, you know, YouTube videos, and even our social media is filled with comments and little video snippets and stuff from the media itself, whether it's the news or popular culture. So what does our culture say about the use of potentially addictive behaviors? For example, liquor advertising expenditures rose more than 620% between 1995 and 1997. So in two years, it went up more than 620%, creating an environment that suggests that alcohol consumption and over consumption are normal. You know, I watch a lot of these shows still, and I see people, you know, they have a liquor in their desk drawer at the office, and they're pouring themselves a drink before they go home or at the end of the day. And I'm thinking, how are you not dui, But. But that's just me and the way my mind works. But it does communicate that going out for a drink after work is pretty normal. So how do people. How do we perceive some of these behaviors? And what does the media tell us about it? Is it, you know, really scary or is it something everybody's doing? Portrayal of people with mood disorders is unstable, and this drives me crazy because the majority of violent crimes are not committed by people who are, you know, actively in a mental health episode. You know, people who are depressed are not violent. People who have anxiety are not violent. Even the majority of people with schizophrenia, especially if they're taking their medication, are not violent. So the portrayal of people with mood disorders is really important to looking at do people seek help when they start having symptoms of problems and help seeking for mood Disorders. Do we have celebrities that are coming out and seeking help and going, yeah, I had a problem. Feeling better now. There were those little bleeps that came on. I think it was cbs. Yeah, CBS cares where they would have celebrities come on who were struggling with depression or anxiety or something and say, you know what? I had this. I got treatment. I'm feeling better now. And I think that went a long way to helping people see that I'm not the only one. And it's okay to have this. It doesn't mean that there's anything wrong with me. And media portrayals of people seeking help have actually improved. You know, think back to One Flew over the Cuckoo's Nest and some of those old fashioned movies from the 50s or whatever and think about things today. I don't know if you've ever watched the show Monk. It was about a police detective who had obsessive compulsive disorder, but he went to see his therapist all the time, almost unhealthfully so. But that's a whole different issue. The movie 28 Days that came out way back in the 90s that sort of popularized or normalized, I guess, addiction treatment. So it wasn't so scary to people. So if the media portrays. It portrays seeking help as okay. If the media portrays people who have mental health issues as, you know, just fine, then it'll encourage more people to come out to seek help and to kind of be real and genuine. Culturally method. Culturally modeled methods of coping, such as using substances, enacting violently to conflict, or prayer. You know, obviously different ends of the spectrum also affect mental health and how people are reacting to what's going on in life. How are they coping with it? Are they avoiding it? Are they lashing out? Or are they trying to do something, you know, through prayer with their higher power? We also want to look at stressors in the culture that promote anger, anxiety and depression. There's always been stressors, but there are times you can look over the past 200 years where there have been fewer stressors or different stressors. So we want to take a look at what stressors are promoting. Dysphoria, for lack of a better global term. And what can we as clinicians do to help people have an arsenal to defend against those stressors and deal with those stressors when they come? And then there's also always an element of people who reject or are non conformant to the dominant culture. If the dominant culture is very segregated, if you will, and somebody doesn't adhere to the dominant cultures values and ideals Then that can promote depression, anxiety, a whole host of other problems. So it's important to look, when we're working with clients to examine what does the dominant culture say about your. Who you are, how you feel, your lifestyle choices, whatever it is, and how is that impacting you? And what can we do as clinicians? Advocate, educate and advocate other cultural influences that may contribute to the development of depression and anxiety. Social media and just never being offline, always being connected is exhausting. Our brains were not designed for that. So important to pay attention to. Are you Getting emails at 7, 8, 9 o' clock at night? Are you on social media engaging with people when back back in the day, before the Internet, you would have been relaxing, hanging with family, petting your dog, whatever. There's a lot more uptime and a lot less downtime in current modern culture. Social media disinhibition kind of goes along with that. When people are on social media, whether it's an email or text messages or Facebook, they tend to say things, or they are more likely to say things that they wouldn't say to another person's face because there's that distance. So people tend to be a lot nastier on social media or a lot more argumentative. You know, we have people who just go around and flame other people's posts, which causes anxiety and angst and depression among the consumers of those posts. You know, and we see this in Internet bullying, cyberbullying, but we also see it in, even in our media, where people tend to be a lot snippier with each other when there's not actually an interview going on. When they're talking about somebody, they tend to be a lot more disinhibited than they would be if that person was sitting in the studio with them. Parents are emotionally or physically unavailable. A lot of parents are working two jobs now. There's a lot of stuff going on even if you're not working, if both parents are working just even one job, Junior has football practice and, you know, somebody else has martial arts practice or something, you may be running six ways till Sunday and kind of pass each other in the night. And this can create problems because the parents are less engaged with the children, less able to promote coping skills and help with the developmental process during the teen years, which are so formative. And fewer outlets for extracurricular activities can also be a cultural influence. Some places have transportation barriers so you can't get to. And a lot of small towns, you know, there's not a lot to do in that small town. And unless you can get transportation to the next big town, you know that you can feel bored, you can feel depressed, you can feel isolated. Age barriers. Even when we're talking about volunteering and maybe getting part time jobs legally, it's hard for a lot of youth under the age of 16 to even get volunteer positions because there's so much regulation on it. A lot of places, at least around here, won't even touch anybody under the age of 16. And just a simple lack of opportunities. What is in your community that where you can volunteer, where you can get involved, where you can engage. And I think meetup, meetup.com I think it is, has done a good job with providing some, some types of outlets for people so they can see more things that are going on in their community. Facebook to a certain extent helps people connect. It doesn't seem to do that much around here, but it may in some areas. There are, I think it's. Volunteer.org is the website where it has. They have a lot of everybody puts their volunteer opportunities. Not everybody, but a lot of people do. So people can find places to volunteer and get involved so they have that connection. They're not feeling isolated and they can feel a sense of accomplishment and purpose in their community which helps buffer against social stress and anxiety. There's a long history of substance abuse and mood disorders in the US Patterns of problem development are influenced not only by the individual, but also by social environments in which that individual exists, their friends, co workers and family. We want to fit in, we want to get along community norms. You know, what does your community say is okay? And you can even look within your city. There are going to be communities or places where drug use is common and there are going to be places where you don't even let your dog go to the bathroom in the grass without picking it up. You know, they're just completely different cultural norms in different places in the community. So we need to look at the person's community norms and not just look at it as a city or as a town, but as their neighborhood economics influence. I mean when people are impoverished, when they don't know where their next meal is coming from, when they don't know how they're going to pay the rent. It's a lot of stress. It can contribute to anxiety and depression if they can't access medical care. So we want to look at, you know, a lot of this stuff is since it's the exosystem, we have less ability to affect it so much. But we can advocate and we can provide people tools to buffer against some of these influences and politics, you know, politics and you know, what laws are currently in place and what's getting attention by the government is going to play a role in, you know, which squeaky wheel gets the grease. While we can't directly control politics, economics or culture, we can provide people with resources to respond to negative influences by helping them bolster their self esteem, improve their coping skills, develop strong interpersonal effectiveness skills, have good problem solving skills, and have a sense of self efficacy. If I do something, positive things are going to happen. So just before we go, Beginning in the 1980s, media portrayals of the miracles of pain management with opiates, combined with Jaco's 2001 mandate that pain be assessed and pain management made a priority, contributed to the development of the current opiate problem. So that's an important point to remember. Cocaine has come and gone and come again and it really regained popularity in the 70s and 80s when it was glamorized by the media as non addictive. So we got a lot of bad information. Another thing as clinicians we can do is help people make sure they know how to research stuff to figure out what's accurate. Initiation from the medical community to treat something often leads to more people being treated and a greater availability for diversity. Back to that, you know, pain management. Now we're assessing pain just as much as we assess vital signs. When substances are outlawed, use can be diminished, but it is rarely eliminated. And even if it is diminished, it's going to be replaced by something else. We've seen that over and over and over again. So the take home message there is really looking at why are people using? What is the underlying cause or benefit of use and, and how can we help them achieve that? Which I mean, after you went through these slides, you see there's a lot of stuff that's out there that can contribute to depression, anxiety and addiction that we need to see if we can do a better job of giving the people tools. Giving people tools to deal with life on life's terms as life is at the moment. Okay. Are there any questions? Okay, well, I will see you all hopefully tomorrow. Have a wonderful afternoon. If you enjoy this podcast, please like and subscribe either in your podcast player or on YouTube. You can attend and participate in our live webinars with Dr. Snipes by subscribing at allceus.com counselortoolbox this episode has been brought to you in part by allce.com, providing 24. 7 multimedia continuing education and pre certification training to counselors, therapists and nurses since 2006. Use coupon code counselortoolbox to get a 20% discount off your order this month.