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“I think if I couldn’t ‘vape’ I might go back to smoking.” That and a puff of ‘vape juice’ was my friend’s response when I asked her what her stance was on the recent e-cigarette debates. *Kiara, who was previously a devoted cigarette smoker, has gone from 12 milligrams of nicotine, down to 3 milligrams, and […]
“I think if I couldn’t ‘vape’ I might go back to smoking.” That and a puff of ‘vape juice’ was my friend’s response when I asked her what her stance was on the recent e-cigarette debates. *Kiara, who was previously a devoted cigarette smoker, has gone from 12 milligrams of nicotine, down to 3 milligrams, and hopes to gradually stop vaping entirely. While vaping may be an appealing harm reduction or smoking cessation tool for Kiara, it’s an immensely unknown product. One study found e-cigarettes to be significantly more effective than nicotine replacement therapy (such as the nicotine gum) as a smoking cessation tool. Eighteen percent of the participants vaping quit smoking compared to the 10 percent of those using nicotine replacement therapy. Notably, 80 percent of the successful e-cigarette participants were still reliant on vaping a year later, contrasted to 9 percent of the other group’s reliance on their product. This suggests that knowledge of potential harm is imperative to approximately 30.4 percent using e-cigarettes as a smoking alternative ability to make a well-informed decision.
As of September 19, 2019, the U.S. Centers for Disease Control and Prevention is investigating 380 cases of lung disease, and six deaths, purportedly caused by vaping. The CDC has not yet identified the precise cause, such as specific device, or liquid. While extremely unfortunate, for those using e-cigarettes to stop smoking cigarettes, this number isn’t as frightening as the 480,000 yearly U.S deaths caused by smoking. So, simply from a harm reduction tool perspective and given the absence of longitudinal data, vaping appears to be very much a lesser of two evils. The best choice? Perhaps not. But an effective harm reduction tool? Given the information we have now, it would seem so.
Perhaps the real fear then is surrounding the constantly increasing number of teens vaping. Approximately 1 in 5 high school students and 1 in 20 middle school students reported vaping in the past 30 days in 2018. After seeing a decline in recent years, the CDC found that in 2018, nearly 2 of every 25 high school students, and 1 in 50 middle school students reported having smoked a cigarette in the past 30 days. That is 20.8 percent of high school students reporting e-cigarette use, related to the 8.1 percent reporting cigarette use. There are those who reason that one cannot definitively say that the teenagers who are vaping wouldn’t have otherwise smoked or are using it to stop smoking. Research says otherwise. There have been numerous studies that looked for a link between personality and predispositions to smoking. One study found that teenagers who were not close to their parents and had a more rebellious personality were more likely to smoke. However, attempts to find the same link between vaping and rebelliousness have come up short, and in fact, many of these no-risk taker/low risk of smoking teens began smoking after vaping for a time.
In a 2015 interview with the founders of Juul, a popular e-cigarette company, Ari Atkins, Juul Research and Development Engineer, said “We don’t think a lot about addiction here because we’re not trying to design a cessation product at all… anything about health is not on our mind.” The appeal to teenagers is three-fold, appealing flavors and the absence of the offensive scent, accessibility for all ages, and the marketing tactics, that can all be said to be targeting teenagers and related to lacking federal oversight.
Kiara took personal offense to the heightened stigma of vaping. She described the taste and smell as a pivotal part of her being able to stop smoking, “I understand [that if flavors are banned] it would taste like nicotine, so like cigarettes. I don’t know what I would do, as a huge part of vaping is it releases the social stigma of smelling like cigarettes, and why make the taste undesirable to me as a consumer?” The problem is, the flavor and smell component are a big appeal to teenagers as well and send the message of lacking harm and being young and fun. I don’t see the taste as being imperative to the appeal for adult smokers, but I do understand the smell component. Perhaps there is a way to keep the taste unflavored, but make the smell perfumed.
Kiara isn’t looking to make vaping a free for all and keep the current climate. She noted that she is all about regulation. In 2016, a professor at the University of California took offense to the apparent age requirements, one aspect of the lacking regulatory requisites, as accessibility seemed too easy for the presumed regulations. To test this, he had several teenagers- ages 16 and 17- try and purchase e-liquid from 120 U.S online vape shops. They used their real names, their debit cards, but faked their birthdate to make them appear above 21 years old. However, if they were asked to verify their ages, they gave their real driver’s licenses. A related study was done in North Carolina, a state that prohibits the sale of e-cigs to minors and requires verification of age. The study found that of the 98 attempted online e-cigarette purchases, 75 were delivered. A few of the online stores stated that verification of age would be required upon delivery, but they did not follow through. Granted, there have been some improvements since 2016, but the regulations on vape product sales to minors need to be far more restrictive, with real consequence.
The North Carolina study above also noted that while these stores claimed not to sell to minors, and not to seek out minors as consumers, some of the orders arrived with candy and little toys. This is clever marketing that sends a very strong subliminal message of playfulness and matches Ari Atkin’s sentiments. Since the popularization of vaping, there have been many advertisements and marketing tactics that seem to target teenagers and suggest harmlessness. In response to a 2014 Blu (a popular e-cigarette company) ad in Sports Illustrated critics said, “Using sex to sell cigarettes is nothing new… and e-cigarettes are pushing the envelope because they’re unregulated.” Blu (a company who has since removed theirs), and other companies used gimmicky cartoons, and advertisements, making more accountability necessary here as well.
So, with improved flavor, age, and overall marketing regulations we may be able to decrease the number of new teenage users, and truly make this about harm reduction and cessation than it previously was. But, how do we account for the many teenagers already addicted? Banning attractive flavors may help prevent further engagement and addiction, but retroactively will it do enough to the teenagers already drawn in, perhaps this should be a matter of focus as well?
The start of a new school year can produce a number of emotions for students and their families. Students can feel excited to see all of their friends again and eager for the fun that follows. They can be nervous about the academics. They might experience anxiety about being back in school. Regardless of the […]
The start of a new school year can produce a number of emotions for students and their families. Students can feel excited to see all of their friends again and eager for the fun that follows. They can be nervous about the academics. They might experience anxiety about being back in school. Regardless of the emotions that they feel, our youth need to be supported at the transition back to school. This article will discuss strategies families can employ to help smooth out the transition process.
One of the most important things to overall mental health and academic performance is having a standard sleep routine. Lack of sleep is a predisposition to negative emotions. What is a normal level of anxiety about a test can become paralyzing with diminished sleep. Establishing a sleep routine is paramount for optimal performance.
Experts recommend removing televisions from youth bedrooms. An estimated 60-70% of U.S. youth have televisions in their bedrooms. Numerous studies show that this adversely impacts sleep. Getting televisions out of the bedroom is a great first step. However more steps need to follow. Smartphones and laptops also need to be removed from bedrooms.
Ask your children what they are interested in. Find activities aligned with their interests. Try new things to see what sticks. Extracurricular involvement can provide an enriching experience. It can also provide additional structure to kids schedules. It is not ideal for children to come home to an empty house with nothing to do after the school day ends. Extracurricular activities can serve as a way for children to stay busy and active.
Do not believe that your kids are doing well based on what they are posting on social media. Check in with your children and really gauge how they are doing. The start of the school year can be marked with anxiety, depression, loneliness, and bullying. Have dinner with them every week and pay attention to the answers your children provide. Talk to the parents of your children’s friends.
Establish rules regarding social media and technology use in the household and stand by them. The average teenager spends between seven to nine hours per day on screens for entertainment purposes (social media, video games, television). Some good areas for rules include:
Talk to the parents of your children’s friends. Share with them your household rules and the rationale behind them. It is difficult to be “the only kid” in school who is not allowed to have an electronic device in their bedroom. Try to create a community based on similar rules so that your children aren’t the only ones with them.
If you have concerns about your child’s emotional health please do not hesitate to seek professional help. Reach out to us here at NJFAI with any questions or concerns that you have. Watch your children and trust your gut if you have concerns.
The first death directly linked to vaping occurred in Illinois. Over the course of this summer the U.S. Centers for Disease Control and Prevention (CDC) found that 193 people were hospitalized with lung illness linked to vaping. Doctors have been astounded by the level of lung damage that they have seen in the patients. Not […]
The first death directly linked to vaping occurred in Illinois. Over the course of this summer the U.S. Centers for Disease Control and Prevention (CDC) found that 193 people were hospitalized with lung illness linked to vaping. Doctors have been astounded by the level of lung damage that they have seen in the patients.
Not only is the lung damage severe, but it is occurring in young people. In Illinois, the 22 people hospitalized for lung damage are between the ages of 17 and 38.
Recently the FDA Commissioner described teenage vaping approaching epidemic levels. Recent studies show a 75% increase in e-cigarette use among high school students from 2017 to 2018.
Teachers and parents
One of the main marketing campaigns of e-cigarettes is that they are a safe alternative to traditional nicotine products. However research shows that youth who use e-cigarette products are four times more likely to start smoking traditional tobacco products. It turns out that using vaping products is a soft introduction to tobacco products. Vaping can normalize smoking behavior. This same phenomenon occurs with loot boxes in video games which normalize gambling.
Doctors are still trying to get a handle on what is happening with these young patients going to the emergency room with such severe lung damage. The main concern with vaping is that users are filling their lungs with foreign agents. Since vaping is relatively new we have very little information on the long-term impact of it. There are significant concerns regarding the inhalation of heavy metal products from the heating coils. Additionally some users are adding liquid THC and CBD to their vapes. There is a complete lack of research on the long-term impact of using vapes for marijuana consumption.
While e-cigarettes have been around for a decade, they were not classified as medical devices or drugs. This limited the FDA’s regulatory powers over it. The lack of oversight allowed the e-cigarette industry to rapidly grow with very few regulations. With no clear regulatory body to provide oversight there are limited safety standards. The recent concerns of e-cigarettes have only surfaced because doctors started reporting adverse events to the medical state board.
The dramatic increases in reported adverse medical events over this summer have brought concerns regarding the safety of e-cigarettes to the surface. Due to a lack of research we do not know how safe or unsafe e-cigarettes are. The severity of the reported medical conditions is very troubling. While 193 cases (including 1 death) have been reported, the lack of a clear reporting mechanism for these events indicates that the true number of medical conditions is probably low. It is imperative that e-cigarette use in teens and young adults be limited. If you have any questions please feel free to reach out to us here at NJFAI. We are happy to provide assistance.
by Anthony Gallo Forward The following article is based upon an interview conducted by the writer with an individual who served a brief sentence in federal prison. It describes the feelings of disenfranchised grief experienced by this individual after his release. All names have been changed to protect the individual’s identities. Due to a dearth […]
by Anthony Gallo
Forward
The following article is based upon an interview conducted by the writer with an individual who served a brief sentence in federal prison. It describes the feelings of disenfranchised grief experienced by this individual after his release. All names have been changed to protect the individual’s identities. Due to a dearth of scientific research on disenfranchised grief in this context, many of the opinions expressed are based upon anecdotal evidence and extensions of related theory developed in other contexts. The article serves as an introduction to this form of disenfranchised grief for both the counselor and the ex-offender, as well as a call to action in expanding research on this topic.
Coming Home: Disenfranchised Grief
Unable to sleep, John stared up at the ceiling feeling the strangely soft sheets against his skin. The room was quiet, and the night was uncomfortably still. John thought of the men he considered brothers, sleeping far away in less luxurious accommodations. The brothers he had left behind, who had grown to know him better than anyone had before. Though he had to go, John still felt pangs of guilt for leaving. Everyone told him how lucky he was to be out, but he wanted to go back. A tear trickled down his cheek. “What is wrong with me?” he thought as his mind raced back to the night before, when his brothers and he celebrated his last night being “down.”
Suddenly the bed rustled, and John glanced over at Jenna, the woman that he loved, sleeping peacefully at his side. She had stayed with him through thick and thin, to the envy of his friends, and faithfully visited every two weeks. Now they were finally reunited, in a luxurious resort no less, yet John only felt sad and alone that night. He thought of waking her and sharing how he felt, but she was happy to have him back and he didn’t want to risk hurting or worrying her. John also knew that he could never fully convey what it was like in there, or who he had to become to survive. There were so many things John couldn’t, or wouldn’t, tell her out of fear that she wouldn’t understand.
After a sleepless night John woke Jenna and they walked together to the resort’s fitness center for his daily lifting routine. Working out was familiar, and John wanted to feel a little bit of normalcy again. He picked dumbbells off the rack, finished a set of curls, and placed them down to use the restroom. John returned to find that a man in his late sixties, with thinning white hair and a frail frame, had commandeered his weights to do lunges in the corner. Taking another man’s weight was a major disrespect and John quickly began formulating a plan to save face.
John clenched his fists as anger boiled inside of him, threatening to spill out of his mind and into action. Sensing John’s tension, Jenna tugged his arm and asked, “Is everything okay?” With Jenna’s touch the spell was suddenly broken, and John’s rage melted into shame and embarrassment at what might have just happened. John dismissed Jenna’s inquiry, afraid of what she would think if she knew that John had planned to confront this man. How could John expect her to understand his thoughts to assail someone older than their fathers over such a minor slight? John was caught between two worlds. His reaction would have made sense to his brothers but would have been deemed highly inappropriate by Jenna. John didn’t know where he fit in anymore.
Released the day before from Federal Correctional Institute Ft. Dix, John’s time being “down,” a slang term for incarcerated, was now over. John had dreamed of this day and coming home was supposed to be glorious. Yet he felt alone, depressed, and overwhelmed readjusting to society. Unknowingly, John was grieving over the loss of some elements of his time incarcerated. John kept most of this grief inside, feeling as if others wouldn’t understand or care. He was experiencing a type of grief called disenfranchised grief.
Introduced by Dr. Kenneth Doka in 1989, the term disenfranchised grief refers to any grief that falls outside the norms and rules that society sets for which losses are appropriate to mourn, who can mourn them, and for how long the losses can be mourned. For example, society would allow someone to mourn the loss of a spouse but generally would not accommodate someone’s grief over the death of a mistress or lover. While the relationship with a spouse is accepted to be legitimate and significant, a person’s relationship with a lover or mistress is taboo and therefore unacceptable to grieve over. Grieving over the return from incarceration generally falls outside the norms of acceptable grief in our society as well.
Despite having goals of reforming the inmates they house, prisons are generally regarded as horrible places that subject inmates to purely punitive and negative experiences. Few people choose to go to prison and many spend significant resources in the fight against being incarcerated. Incarceration physically restricts an individual’s freedom, puts employment on hold, removes them from their family and friends, and subjects them to elevated risks of bodily harm. Being incarcerated also often strips them of their personal identity, rights, and life purpose while drastically lowering their standard of living.
With incarceration being perceived so negatively, being released from prison is often visualized to be a wholly positive experience for the ex-offender. They have theoretically paid their debt to society and now get to return to their family and friends, re-assume their identities, regain their personal autonomy, and resume their lives and careers. They can more freely navigate the world and make their own decisions and also regain most of the rights they had prior to their time incarcerated. How then, do some inmates grieve over what should be a wonderful moment in their lives?
To answer this, we must begin by acknowledging that not all aspects of prison are bad, and not everyone has the type of traumatic experience that society expects to befall them while incarcerated. This is not intended to minimize the negative impacts incarceration has on many inmates’ lives or to justify the major issues caused by the US prison industrial complex, it simply recognizes that some inmates may find parts of their experience to be positive and fulfilling. Ignoring this fact leaves little room for understanding or empathizing with the disenfranchised grief experienced by some inmates returning to society.
In 1943, an American psychologist name Abraham Maslow developed an overarching theory of human motivation titled the Hierarchy of Needs. Adapted to the context of incarceration, his theory helps shed light on why some inmates might miss prison. Maslow theorized that humans have different needs that must be met in a sequence he ordered by physiological needs, safety needs, love and belongingness needs, esteem needs, and self-actualization needs. Physiological needs are the biological requirements for the body to function and were viewed as essential to have met before satisfying higher needs. Safety needs refer to the protection of the human from the elements and from physical harm, while love and belongingness needs include developing friendships, intimacy, trust, and acceptance. Esteem needs include aspects such as personal dignity, feelings of competence, and status or prestige. According to Maslow, the ultimate goal of meeting a human’s self-actualization needs include achieving fulfillment “to become everything one is capable of becoming.”
John’s experience shows that prison may be capable of satisfying most, if not all, of these human needs. Physiological needs are always met, even if the food and drink are sub-standard, and safety needs are generally met via consistent housing, rules, and structure in the inmates’ lives. Many love and belongingness needs can also be met inside the prison walls, either through gang involvement or close friendships. Esteem needs are sometimes met when inmates develop valuable roles in the inmate community, either informally or via their work assignments. Lastly, self-actualization needs could possibly be met through finding one’s calling within the walls of the prison, such as the jailhouse lawyer that helps overturn his fellows’ cases.
While interviewing John for this article, he shared that he had indeed felt like all his needs, other than self-actualization, had been met while incarcerated. He never had to worry about food or shelter while incarcerated. John also shared that his love and belongingness needs had been met by the close relationships he formed with a select few of his fellow inmates; men he came to regard as brothers more than friends. John also felt that his esteem needs were met through the value he brought to the community by cooking, working in the gym, and serving as a confidant for many inmates who felt comfortable speaking with him about sensitive matters.
John’s physiological needs remained satisfied upon release. However, despite having a close-knit family and the presence of Jenna in his life, John consistently expressed that his love and belongingness needs went largely unmet upon his return home. To illuminate his point John made comparisons to the experiences shared by Sebastien Junger, a journalist who spent his career covering military conflict, during a TED talk on why military veterans miss war.
In the talk, Junger describes an interaction with a traumatized soldier named Brendan who had experienced death and vicious fighting on the battlefield. When asked if there was anything he missed about the war, the soldier responded, “I miss almost all of it.” Junger theorized that it was not the violence, death, or the trauma that this soldier missed, but the feeling of brotherhood he had left behind on the battlefield. Brendan missed the human connection he experienced by enduring intense hardships with his fellow soldiers, who he also came to consider as brothers. Junger went on to explain that brotherhood is a mutual agreement in a group that an individual will put the welfare of the group over the welfare of the individual. Humans are intensely social creatures and we tend to immensely enjoy such interpersonal connections. Unfortunately, civilian society’s luxuries of independence rarely afford such opportunities for true brotherhood.
John shared that he felt this sense of brotherhood amongst his closest friends in prison and he was unable to replicate it in life on the outside. John had grown to rely upon those men for his safety and emotional well-being. He trusted them to share their limited resources when in need and to expose themselves to physical danger to protect him, and they knew he would do the same in return. Spending so much time together, with nothing to do but talk, he had formed incredibly close bonds with these men and felt that they knew him better than anyone had before. When he returned home, he questioned what his friends at home would really do for him when the chips were down. How could he ever hope to feel as intense of a connection with friends who wouldn’t be willing to give their life to protect his? He wondered whether they could ever understand him and worse, whether they would judge him for the humor and customs he had developed while incarcerated.
It is not known how common John’s experience is amongst inmates returning from the criminal justice system. In researching John’s experience this writer was unable to locate any scholarly research on disenfranchised grief relating to release from incarceration. There is significant work showing the impacts of maladapted traumatic grief on incarceration and recidivism but seemingly none on the grief experienced after release. There is also much study of the similar concept of “institutionalization” but the articles reviewed largely focused on recidivism rates due to mental health, substance use, traumatic grief, and unemployment. However, this writer did find ample anecdotal evidence that John’s experience was shared by other ex-offenders by reviewing posts in online forums. The following excerpt is from one of those forum threads:
“I just think sometimes how dam stupid it all sounds…. I mean being down for 5 years in a basically max security prison and getting out and missing it. I think to myself what the hell is wrong with me? I do love my freedom I don’t want you to misunderstand me. And when I was locked up I wanted to get out so badly. And I do love life and freedom…..it’s just….I am so changed in every way and feel so alone sometimes. What’s weird though is being surrounded by people bothers me and all I can think about is leaving where I am.” – Skitten1208
John’s and Skitten1208’s experience of wondering “what is wrong with me?” struck the writer as extremely poignant examples of the difficulties posed by disenfranchised grief. When individuals experience an acceptable loss, society has already set an expectation of grief and they understand that it is okay to feel and express sadness. Additionally, they enjoy the healing benefits of empathy and understanding from friends and family, as well as an ability to engage in social mourning rituals. With disenfranchised grief there are no such expectations or emotional support for the grieving individual. These grievers therefore may not understand their grief or that their emotions are in fact natural and healthy. They may also feel intense alienation and shame for missing something that society deems that they shouldn’t.
With no research available on this specific form of disenfranchised grief, work with ex-offenders should focus on the general therapeutic concepts of treating disenfranchised grief. The counselor should stress that the grief is indeed valid, despite falling outside of societal norms, and that there is nothing wrong with the individual for grieving. Furthermore, the counselor should take time to listen to the individual and allow them to express their feeling of loss. The time in session may very well be the individual’s first opportunity to do so. It is also important that the counselor expresses an understanding of the loss through techniques such as reflecting, paraphrasing, and summarizing. The longer an individual’s grief goes without acknowledgement or legitimacy the longer it may take to resolve.
In addition to working with the affected individuals, this writer believes it is vitally important to begin conducting research on disenfranchised grief in this context. If this experience is not recognized or studied by the very professionals who make a living examining such concepts, then how can we expect impacted individuals and mental health professionals to recognize or understand it themselves? In fact, the lack of research seems to prove exactly how disenfranchised this type of grief truly is. We need to understand how common this type of grief is, how it impacts the individuals affected by it, how to treat it, and how it may play into the larger examination of recidivism in the criminal justice system.
It is this writer’s hope that this article can spur conversation and research around the topic. At the very least, the writer hopes to have shown individuals like John and Skitten1208 that there is, in fact, nothing wrong with them at all. Though society might not yet accept it, this article can play a small part in validating their experience and right to grieve.
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Anthony Gallo is a Licensed Social Worker and Licensed Clinical Alcohol and Drug Counselor Intern with a Master’s Degree in Social Work from Rutgers University. Anthony’s experience with direct patient care complements his passion for macro social work, enabling him to promote practical legislation and outcomes focused business practices. In his personal life, Anthony is an avid auto enthusiast and enjoys theater, photography, and polishing opals.
This is the second article on epigenetics. The first article can be read here. It was written by Danielle Victoriano, an intern from Princeton University. Rise of Substance Abusers In recent years, the growing number of substance abusers in the United States has become a topic of national discussion. The death toll from overdoses continues […]
This is the second article on epigenetics. The first article can be read here. It was written by Danielle Victoriano, an intern from Princeton University.
In recent years, the growing number of substance abusers in the United States has become a topic of national discussion. The death toll from overdoses continues to skyrocket. 63,600 people died from overdoses in 2016 alone. This was a 21% increase from 2015.
As the death toll rises substances abusers, family members, counselors, and scientists are desperately searching for solutions. From all this turmoil has arisen a potential aid in the fight against substance abuse: epigenetics.
The topic of epigenetics cannot be breached without a better understanding of DNA, the material inside cells that serves as the language of life. DNA is the command center for why we look the way we look, and sometimes, why we behave the way we behave.
DNA or deoxyribose nucleic acid can be broken down to four bases:
Each of these bases are attached to a phosphate group and a sugar. This combination of bases, sugars, and phosphate groups form the double-helix ladder that often comes to mind when we think about DNA.
However, this viewpoint is wholly incomplete. It must be understood that the DNA ladder also actually wraps itself around proteins called histones. The tightness from the wounding around these histone proteins regulate which parts of the gene are expressed and repressed. The closer the histone proteins are to each other, the tighter the DNA is wound, and thus, the harder it is for the DNA-encoding machinery to access the DNA material. The further away the histone proteins are to each other, the looser the DNA is wound, which means that it is easier for gene expression to occur.
The distance by which histone proteins are from each other and the tightness of the DNA wounding around these proteins is determined by two chemical groups. Attachments of methyl groups on either the DNA itself or on the histone proteins are associated with repressing, or turning off the expression of a gene, while acetyl groups are associated with expression, or turning on the expression of a gene. Methylating the DNA and/or methylating the histone proteins tightens up the DNA-protein interaction, while acetylating the histone proteins opens up the gene and allows for expression.
To think about it more simply, imagine a flashlight that’s been turned on. Now, imagine a hand covering it. To open up the fingers over the flashlight means that light will pass through. To close the fingers over the flashlight means that light will not be able to pass through. This is similar to how epigenetic modifications to the human genome works. The light represents the fact that the DNA material will be there, it is whether or not the hand is open or closed that will factor in to if the gene is actually repressed or expressed. When the hand is open, there is expression, and when the hand is closed, there is repression.
Thus, epigenetics is the study of how the human genome is modified not through changes in the base pair sequence, but how the structure of DNA and protein is modified through attachments of chemical groups that alter the configuration.
The blossoming field of epigenetics has paved the way to discovery of epigenetic markers brought by substance abuse. By epigenetic markers, this means that genes have been identified to be methylated or acetylated differently from the norm.
One substance misuse disorder that is of high importance to public policy is the abuse of opiates. According to the Center for Disease Control, in 2016, around 66% of the 63,600 drug-overdose related deaths involved opioid use.
Researchers have found that in opioid addictive patients, there is more expression of a certain neuro-excitatory gene, GRA1, that would account for the addiction’s withdrawal symptoms such as restlessness, muscle twitching, and dilated pupils. This overexpression can be attributed to hyperacetylation of the neuro-excitatory gene. Hyperacetylation means that the gene is constantly being expressed, which leads to more expression than usual.
Alcohol is yet another substance misuse disorder that has been identified to have epigenetic markers. With alcohol use, researchers have found dysregulated amount of protein factors in the brain through abnormal methylation and acetylation patterns in some genes. In turn, during the active influence of alcohol, there is high concentration of the protein Arc, which is associated with decreased levels of anxiety and stress. This relationship results in alcohol-dependence to combat negative emotions that can be seen in many individuals with alcohol misuse disorders.
Knowing the existence of these epigenetic markers, and being able to identify and locate where they are in the human genome opens up a whole new realm of opportunity in terms of treatment options in substance abuse recovery. Potentially, the current rates of relapse that follow inpatient detoxification treatments could be curbed. As of 2015, it is reported that more than 85% of substance misuse patients relapse and return to substance use within a year following treatment. Since withdrawal symptoms are a trigger for relapse, imagine being able to control and limit those symptoms by targeting the epigenetic markers that caused the symptoms in the first place. Imagine being able to de-acetylate the neuro-excitatory gene, GRA1, that is constituently turned on in those with opioid abuse. This would most likely make early recovery easier, less painful, and less daunting.
Medications that are currently being examined to combat substance abuse are histone deacetylase inhibitors (HDAC inhibitors) and DNA methylation inhibitors (DNMT inhibitors). These medications would attempt to re-regulate the imbalance that have been produced by epigenetic modifications in the body, by reversing or inhibiting the effects of methyl groups and acetyl groups.
Though research is still in its infancy, with no current research on how these medications affect humans, results have shown to be promising. One research study looked at the effects of having histone deacetylase inhibitors in rats with alcohol addiction and found that with HDAC medication, these rats are less likely to seek out or self-administer alcohol.
In terms of non-medication related treatments, there has been a promising finding that exercise can be used to reverse some of the epigenetic modifications made from chronic alcohol abuse. It has been found through rat studies that exercise has restored the brain physiology that has been altered by chronic drinking. Alcohol-addicted mice that were treated with regular exercise had improved memories and brain activities when compared to the non-treatment group.
Despite these success stories in controlled environments, there is still a lot more that needs to be done before this new technology can be used in humans. Currently, we simply do not have the technology to selectively choose genes that are specifically targeted by different addictive stimuli. However, we are hopeful that this new field will take off. With growing interest from research institutes in the national and global arenas, we can hope that the awaited future of epigenetics is not that far.
This article is part one of three on going to college. This article will focus on tips to help students transition into college. Part two will focus on tips for younger siblings. Part three will focus on parents. In a few days I will be going on a service trip to Poland with a group […]
This article is part one of three on going to college. This article will focus on tips to help students transition into college. Part two will focus on tips for younger siblings. Part three will focus on parents.
In a few days I will be going on a service trip to Poland with a group of youths from Florham Park. The kid are between 12 and 18 years old. The majority of them are 18 and transitioning to college in September. Being around them has made me reflect on my own transition into college years ago. I am the youngest of four boys. When my oldest brother went to college I cried. Intuitively I knew that we would never all live under the same roof together. My brothers and I made a ritual. The last night that they were home before they went to school we would spend the night together watching movies.
By the time I went to school I was the only one living at home. I had the latest move in date for my group of friends. I remember my last night I felt conflicting emotions. I was excited but also slightly sad. I realized that I was moving on from the home that I had always known. I also felt slightly guilty for leaving my parents. I was worried about how they would cope with an empty house. It was also slightly terrifying to go to school where I didn’t know anyone. I knew I would have to make a new group of friends which is something I hadn’t done in years.
Anxiety, depression, stress and feeling overwhelmed are very common on college campuses. Below are some statistics on the prevalence of these feelings.
Clearly college students are struggling. The transition to college that I experienced is not uncommon. Below is a list of tips for college students to help with their transition.
Having a steady sleep routine is important. I have always been a reader. Most nights in college I would turn off all of my electronic devices and read for at least half an hour before I went to bed. My freshman year we had a television in my dorm room. That was one of only two years that I had a television in my bedroom. Avoid falling asleep with the television on.
Proper nutrition is key. College dining halls aren’t know for putting out the most healthy food. Rather they serve food that is cheap to buy in bulk. However most dining halls do have health options including salad bars and plenty of fruit. Most days I had a salad for lunch and took a piece of fruit on my way out for a snack.
Exercise is very important for overall health and well-being. It is also a strong combatant to stress and depression. Almost all colleges have gyms that students can use for free. If you aren’t into lifting weights that is fine. Alternatives could be intramural sports leagues, swimming, dance classes, and other options.
While college can be a time for fun it shouldn’t come at the cost of academics. College is just a phase of your life but how you perform academically can impact you career options initially. College shouldn’t be a four year party. Perform well academically and it can open up a lot of doors.
College professors are different than high school teachers. They have much more limited time with students and more demands. I strongly recommend going to office hours and getting to know your professors. If they know your name, face, and about you I have found that they are willing to help. They also have extensive networks which never hurts when searching for internships and jobs. While in college I developed relationships with several professors. When it came time for grad school I needed letters of recommendation for the admissions board to review. I approached two professors who I had cultivated relationships with over the years and asked for letters of recommendation. They disclosed to me that they were the grad school admissions board. They happily wrote letters to themselves recommending that I be accepted to grad school. Professors can open a lot of doors.
My experience is that in college keeping up academically is like drinking from a fire house. I found early on that my dorm room was not a good place to study. There were too many distractions and friends popping in to hang out. I quickly found a quiet spot on the 4th floor of the library where few people ventured. I ended up spending countless hours at “my table” doing my work and studying. Over the years I found other spots that were great for studying. They were always quiet and rarely used. Find your spot or spots that work for you.
Most college campuses have tutoring centers and services. These are usually provided for free and cover most major topics. I found that the classroom lectures and independent practice were not enough for me to thoroughly understand the material, particularly science and math courses. I ended up spending hours at the counseling center going over my work with tutors. This helped me perform exceptionally well academically.
Most colleges offer free counseling services to students. This is one of the few instances in life where you can get quality therapy for free. Now most of these counseling centers become overwhelmed around midterms and finals. Getting an appointment then can be tricky. Beat the crowds though. Make an early appointment and speak to someone about anything that is effecting you. Laying a strong foundation early on can help prevent depression and anxiety.
Sometimes I hear people say that college was the best time of their life. I find that incredibly sad. For people who say that it means that they peaked when they were 18-22 and they will never be that happy again. Sounds pretty grim to me. College can be a lot of fun. But don’t over hype it. Realize that college is just another phase in life. Have fun but don’t fell pressured that you need to make it the best years of your life.
College campuses have a plethora of organizations that you can join. These are a great way to meet like minded people and to structure your schedule. Find an organization that you are interested in and join it.
College can and should be fun. However it is a time to learn and grow. I have seen countless examples of young adults who only have crazy drunken stories and mediocre grades to show for their years at college. Have fun but keep focused on the fact that you are there to better yourself and your future. Simultaneously don’t take yourself to seriously. All work and no play leads to a dull existence. Realize that you can define what fun is for you. 20% of college students don’t drink. 1 in 3 have 3 drinks or less when they drink. Movies and media today portray college as one giant party for drugs and alcohol. It doesn’t have to be that. Figure out before you go to college what you want out of your experience. I encourage you to dream big and look beyond all the crazy parties. If you ever need someone to talk to reach out to your counseling center or to us.
Sources
https://adaa.org/finding-help/helping-others/college-students/facts
https://www.apa.org/monitor/2013/06/college-students
In one week I will be taking a group of teens to Poland on a service trip. A few nights ago I gathered with their parents to go over the details of the trips and to answer questions. Throughout the trip we will be having a morning lecture focused on issues youth and young adults […]
In one week I will be taking a group of teens to Poland on a service trip. A few nights ago I gathered with their parents to go over the details of the trips and to answer questions. Throughout the trip we will be having a morning lecture focused on issues youth and young adults face. I asked the parents what issues they were concerned about. Social media use was an overwhelming concern.
Social media is something we write and talk about extensively. As therapists and researchers we have serious concerns about the impact it has on our youth. I have a notification system set up so that every time an article on research of the effects of social media is published I got notified. Recently Forbes published a great article on the neuroscience of social media and teen girls.
Instagram is popular to say the least. As of 2018 it had over 1 billion users worldwide. Half of them are daily users. Of the daily users, 60% are females under the age of 34. This is the core group that Instagram focuses on.
One of the co-founders of Instagram was a former student of BJ Fogg. BJ Fogg is the creator of persuasive technology design. His work builds on the research B.F. Skinner. Skinner studied how reward shapes behavior. He famously created a box where he put animals and shaped their behavior by rewarding them.
B.F. Skinner and BJ Fogg found that human behavior could be shaped by rewards as well. Instagram is designed so that users continue to check back frequently. The more users on Instagram and the longer they use it, the more money Instagram can make from advertisements.
Scrolling, tagging, notifications and likes all tap into the fear of missing out. If you aren’t on Instagram constantly then you might miss something and be left out.
Teen Instagram users are exposed to idealized images of other women and life in general every time they use Instagram. They compare how they feel internally to what others project externally on Instagram. They usually come up on the short end of the comparison. Research has clearly linked Instagram (and overall social media) to depression, anxiety, and loneliness.
Brain scans how shown that when girls see a highly rated image, their brain associates it with being better. What they don’t realize is that many of these likes are either fake or purchased. These likes trigger the reward center of the brain so that they feel good. However they are unaware that they are being manipulated for financial purposes.
The design of Instagram is tailored to teen and young adult females. For instance, filters, makeup, lighting, and posing are designed for female use. What teen girls fail to realize is that the pictures they are seeing are not necessarily based in reality.
The popularity of Instagram has also led to the creation of Influencers. These are people with large followings who are paid to post. Kylie Jenner reportedly gets paid $1 million per advertised post.
Average American girls spend 6-10 hours a day on social media. This means they spend a large percentage of the day in a virtual world that is not necessarily a reflection of reality. This has led to dramatic increases in depression, loneliness, and anxiety.
If you have concerns about a loved one’s use of social media please contact us. Extended social media use can result in depression, loneliness, and anxiety. Suicide rates have increased dramatically in the past several years for teen girls. Read our other articles on social media here and here. This is a real issue with real consequences. Please do not hesitate to contact us.
I had been working as a counselor for less than six months when a guy on my caseload told me that he was dying from AIDS. He wasn’t sure if he contracted it from sex or sharing needles. It was late at night and he couldn’t sleep. He told me it took him a few […]
I had been working as a counselor for less than six months when a guy on my caseload told me that he was dying from AIDS. He wasn’t sure if he contracted it from sex or sharing needles. It was late at night and he couldn’t sleep. He told me it took him a few months to feel comfortable enough to open up to me about it.
“It’s hard to focus on staying clean sometimes because I know I’m going to die soon. Every day I have moments where I ask what’s the point.”
He talked about how he had wasted so much time. He was angry at himself and others, but mostly himself. “I’m fucking scared Frank,” he said as his eyes welled up.
“I put it out of my head and once in a while I have a nice moment or a laugh, and then it comes roaring back.”
I stayed later than usual. After that, we fell into a routine. I worked until 11 pm a few nights a week. Usually he’d come into my office around 9 or 930. We’d talk about music, sports, and old movies. Usually we’d delve into some aspect of addiction and/or recovery. He didn’t talk about his diagnosis every night, but when we did, it was pretty deep. I felt inadequate to the task. I had never read anything about how to talk to someone that knew they were going to die. I had not be trained on it. I felt powerless. And then I figured out that my presence was a good start. I learned quickly to mostly listen, though I did ask questions. I never gave him advice or my perspective on his case (or death in general), unless he specifically asked. Eventually another man with a terminal diagnosis joined us. They raged, cried, and occasionally laughed in my office. As time passed, I was touched and honored by how much they shared and trusted me. Both died within two years.
One of my favorite clients ever got sober off of pills and heroin in the summer of 2007. An older male, he had trouble identifying with all the twentysomethings in group that were mostly court mandated. He hung around in an outpatient group for two years. At graduation, he gave me a water color painting that he made for me. “You told me I had to fill my time and I started fishing again. Remember when I went to Alaska late last summer with those other guys in recovery to go fishing? Well, I painted this for you. Do you recognize it?” I did. It was of the Coast Mountains. I had been dazzled by the orca-like patterns of snow on rock when I was in Alaska in the late summer of 2001. I was moved (ever since, the painting has hung in an office or at my house).
In 2011, he was diagnosed with terminal cancer. He relapsed and his health problems rapidly deteriorated. He reached out to me and I met him at an AA meeting in Clinton. I struggled to recognize him, for he had lost so much weight and his skin was ashy. We talked about anger, fear, unfairness, regret, pain, numbness and depression. I tried to help him get and stay clean, but he couldn’t put substances down for any length of time. He died a little over a year later. I went to his funeral and talked to his family. All these years later, I still carry the prayer card from his funeral in my car.
There have been others. There are two people in my life who are not yet 40 that have been diagnosed with terminal cancer (one brain, one breast). I visit my friend with brain cancer every two to three weeks. We have multi-hour discussions that touch upon everything, but we always talk about dying and death. His death. I ask questions. And listen. Sometimes he rages, though it’s rare. We laugh far more than you would guess.
One of the things that really aggravates him is when people ask if he got a second opinion or tried a specific remedy. A few months ago, I told him about my friend’s wife (breast cancer) and how one person reached out to her and told her that if she drank a certain concoction that it should help. And that it really pissed her off. He laughed and said, “It’s amazing how stupid people can be.”
1) Unless you are members of the exact same religion and go to the exact same church/temple/wat/mosque with the exact same spiritual leader, refrain from saying it’s “God’s plan” or “God’s will” or offering up some other religious platitude. I write this as someone who has softened on religion over the last decade (I think it can be a wonderful way to be part of a community and engage in service work). Since humans organized into tribes and towns, we’ve had some kind of spiritual or religious belief system. Religion has attempted to explain (or make sense of) death and comfort both those that are dying and those left behind to mourn. But I think you should be very, very careful about using your religious explanation to help someone you know that is dying. Unless you go to the exact same religious building.
2) If you were dying, I assume that you would read a lot about the diagnosis on the internet (and hopefully books). I expect that you’d do everything you can to get cured or try to prolong your life. And yet, every person with a terminal diagnosis that I have ever spoken with has told me of at least one person who offered them medical advice. The advice could be crystals, potions, medications, Western methods, Eastern methods, eliminating some food, eating specific foods, or something else that evades me right now. I know that you mean well, but everyone I’ve talked to with a terminal diagnosis was irritated by this. Do not try to solve their problem, unless they ask you.
3) Ask them what you can do. If they say nothing, offer to give them a ride to the doctor’s office or the store. Bring food over. If they have kids, offer to watch them one afternoon or evening (if you are the responsible type). A writer that I admire lost his brother to cancer when he was 13. He talked about being on “planet cancer” and how everyone avoided him and his family. Be present.
4) Don’t make it about you.
5) Don’t talk about other people’s experience with the same diagnosis, unless they specifically ask you. They deal with their diagnosis all the time, and they have talked to lots of people about it.
6) Tell them you don’t understand what they are going through. But you will listen to them if they want, without advice. Ask them what they need from a conversation. To yell, cry, laugh, distract, mourn, ache, or plan. Everyone is different. There is a lot more here, but this is a good primer. If you find yourself in this position and want to know how to listen and talk to someone about this, we can have a quick chat about it.
The first five are easy. You just need to be aware of them. The sixth one is difficult, and most people aren’t up to it. That’s ok. If you can do 1-2-3-4-5, you are a good friend or competent family member.
Many Americans feel very stressed, and a lot of people worry about burnout at their jobs. While I sympathize with those schedules and stressors, there are a few jobs that are in a different class all together. I have counseled thousands of people from all types of vocations, but over the last decade, I have done a lot […]
Many Americans feel very stressed, and a lot of people worry about burnout at their jobs. While I sympathize with those schedules and stressors, there are a few jobs that are in a different class all together. I have counseled thousands of people from all types of vocations, but over the last decade, I have done a lot of work with law enforcement officers, correction officers, current service members and veterans, and social workers. These are high stress jobs that affect both the workers and their families. I have a very strict definition of a high-stress job (full disclosure: none of my work meets my criteria for high stress). It means:
A) one’s physical safety is under regular or constant threat
and/or
B) one sees/deals with horrible things happening to people under 18 years old
To be clear, horrible things can mean malnutrition, verbal abuse, physical abuse, sexual abuse, burning, mutilation, and/or death.
Most correction officers meet the criteria for A. Many law enforcement officers do as well. Some service members do. Social workers who are working in prisons or child protective service agencies certainly do. PTSD or complex PTSD (C-PTSD, which the public and even most professionals don’t know about) are more common than not in people with those jobs who meet criteria A.
Unless the correction officers work in a juvenile detention facility, they won’t bump into criteria B. Law enforcement does, particularly those who deal with domestic violence calls, car crashes, and most horrifically, child sex crimes. Almost all child protection service workers come across neglect and physical abuse, and many have to deal with the fall out from sexual abuse. Those who are in the military and come upon dead children in war zones are usually haunted by those images (I’m not even going to write about those who had to take the life of a child soldier or child suicide bomber, as I doubt I have the power to explain that situation to civilians). In the summer of 2017, I spent some time talking to an Army sniper who worked as a fire fighter when he wasn’t on active duty. He told me about how difficult it was to come across the bodies of burnt up children. I asked him how common it was. He said it didn’t happen much, but that most firefighters he knew that spent 20+ years on the job had seen that. Of course, I asked him if he or other firefighters had a chance to process it with a therapist who understood trauma. He laughed and said, “Of course not.” To be clear, anyone who meets criteria B over a sustained period of time is very likely to have symptoms of PTSD or C-PTSD.
I have grave concerns for these professionals and public servants, because their work is vital to our society. They are the ones with their hands in the muck. And the work does a number on them and their families. And their families. The jobs can be overwhelming, and there usually isn’t mental health and community support to deal with the side effects of the work.
In the aforementioned professions that meet one or both of the criteria, the following conditions are more common than in the general population:
substance misuse, anxiety, depression, PTSD, C-PTSD, disorganized gambling disorder, suicidal ideation
Those public servants are also more likely to have poor spending habits (using money to feel better), act out sexually, put themselves in dangerous situations (driving a motorcycle with a helmet, engaging in extreme sports, going into buildings without backup), isolate at the end of the day, and have marriages that end in divorce.
Because most are in jobs where being tough is a value, therapy is usually not offered and often looked down upon. “People who go there are weak” I often hear or “Other people have it worse.” I tell them if they meet the criteria for A or B, that very few people actually have it worse. They usually don’t tell their spouses about their work. They might utter “rough day” or “the usual” or “you don’t wanna know” or just sigh and go silent. Some variation.
The job changes them (how can it not?). They become quicker to anger and quicker to isolate. Spouses may resent how their partner has changed. And their partner doesn’t know how to explain it. And there is a strong chance that they aren’t any good at listening to their spouse talk about their less stressful job.
To be clear, I’m not asking spouses and family members and friends to excuse bad behavior that these professionals use as coping skills. I don’t want you to be their therapist. I just want you to understand that the work is horrifying. Here is what you can do:
1) Encourage the professional to go to therapy. Continually. They need at least one person in their life that they can process these terribly experiences with continually.
2) Monitor their sleeping and eating.
3) Encourage them to exercise regularly.
4) Monitor their substance intake.
5) Come up with a way for them to signal to you that they had a particularly rough day on the job.
6) Try to understand that they will probably be poor at listening to you talk about the stressors of your job and day. This is often a common complaint from couples where one person is in a high stress job.
7) For those of you that are spouses, it is imperative that you spend time together outside of the house, at least two days or nights a month. This is important for both their stress level and your relationship (all too often, a decade into a romantic relationship, it seems like you are running a daycare/housing/taxi service with no downtime for yourselves or each other…this leads to stress, resentments and potential awful fights).
I’ll get back to this before the end of the summer. For those of you that are friends of someone in those jobs, you can play a significant part in their well being. Please do so.
I have Patrick’s permission to share this photo and a bit of his story. This picture was taken on Wednesday, June 12 at the 2019 Recovery High School Graduation (the full name of the school is the Raymond J. Lesniak Experience Strength and Hope High School). The high school’s recovery support is staffed by Prevention Links, […]
I have Patrick’s permission to share this photo and a bit of his story.
This picture was taken on Wednesday, June 12 at the 2019 Recovery High School Graduation (the full name of the school is the Raymond J. Lesniak Experience Strength and Hope High School). The high school’s recovery support is staffed by Prevention Links, a non-profit that I have worked at since the summer of 2017. The administration and the academics are provided by Union County Vo-Tech. It has been a wonderful and unique partnership between those organizations. The school has been located at the Prevention Links building in Roselle for the last few years. In 2019, Morgan Thompson became the CEO of Prevention Links. She is a Rutgers graduate (twice over), a person in long-term recovery, and (allow me to brag) a former student of mine.
Patrick struggled with substances during his freshman year. Things got worse. He bounced in and out of treatment. Switched schools. He was nasty to his parents and surrounded himself with negative peers. His grades plummeted. He was constantly in trouble. And usually high. Many people worried about his trajectory – the outlook was grim.
Patrick entered into recovery in August of 2017. He came to the Recovery High School in the fall. There were only a handful of students. While he missed the robust size of Metuchen, he worked closely with his recovery mentor, got a sponsor, spent time with his sober uncle, and began to apply himself in school. I would show up every couple of weeks and take him for a walk, regardless of whether it was hot, cold, or raining. We talked about school, his parents, girls, addiction, recovery, music, and his post high school plans. I enjoyed our walks.
The school grew and grew. This year we had almost two dozen students. Patrick was a leader and a role model. He had a bit of early senioritis, but he finished strong. And stayed sober the whole time. Patrick is going to college out of state (I wish he was going to Rutgers, but he is going to help his school develop their own recovery housing program).
At graduation, Patrick gave the student address. The NJ Commissioner of Education was there, along with some state legislators, several Union County Freeholders, the County superintendent, and a number of other officials who normally are not at high school graduations. The school has been able to thrive because of our diverse and powerful group of supporters. Patrick didn’t realize it, but he was under a bit of pressure to make a good impression. There were several speeches before him, and I could see that he was getting a little bored. From the audience, I have gave him a number of facial and hand signals to smile and bear with it.
When it was his turn to talk, he slayed it. He spoke about his addiction and the problems he caused his family. There were several moments that I teared up. He took us on a rollercoaster ride. It started quite sad. Painful. Then I felt hopeful. And pride. Near the end, he made us laugh a bunch. It was a killer speech (you should have been there).
I’ve been working in the addiction and recovery field for 16 years. There have been a lot of hard moments, in both the clinical and policy arenas. I’ve seen a lot of despair and death. I need moments like last Wednesday, when I get to see someone who has gotten sober communicate to others the joy and power of the journey. People can get clean and sober at any age, but the younger they do it, the less wreckage they have to clear. They also have a higher ceiling. I’ve been working with college students for a long time and will continue to do so. But getting sober in high school? Crazy. Inspirational. Life changing.
Great job Patrick. I’m so proud of you. Keep helping others.
To read more articles like this about being a mentor click here or click here to read about my recovery spring breaks.
