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Mental Health

Standards of Self-Care Series 3 of 3

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In the final article in the series reviewing the Standards of Self-Care established by The Green Cross Academy of Traumatology, we cover the section on Inventory of Self-Care Practices.  These practices fall into one of three categories; Personal, Social/Interpersonal and Professional.

Personal self-care practices include both physical and psychological strategies.  These have been noted as engaging in bodywork to release tension, getting proper sleep and proper nutrition. In addition, this category includes relaxation time, time in nature and creative expression.  Other recommended skills include assertiveness, stress reduction, interpersonal communication, cognitive restructuring and time management.

self-careFBUnder Social and Interpersonal self-care, the guidelines state that we should have “at least five people, including at least two at work, who will be highly supportive when called upon.” I think this is great because as helpers we sometimes struggle to ask for help.  To know that the bar is being held at finding five people, whom we are willing to ask for help, puts us in a solid position to stay healthy.

In addition this category includes getting help personally and professionally as well as engaging in social activism that brings a sense of satisfaction for trying to make change.

The final category, professional self-care, is all about Boundaries, Boundaries, Boundaries.  This section recommends setting boundaries to keep work and home separate, time boundaries to prevent overworking, therapeutic boundaries and personal boundaries.

It ends with this statement, which I one hundred percent believe is necessary. “Realism in differentiating between things one can change and accepting the others.”

The reason I love this last guideline is because over the course of my work as a Compassion Fatigue Coach, I find this to be the single biggest barrier to implementing all of the other self-care strategies.

Because helpers tend to have giant hearts and tend to work with people who have multiple struggles and needs, the ability to accept what can be changed and what cannot be changed (at least in that moment, with the resources they have) is very difficult.

The inability to accept that maybe you can’t solve all the struggles in the immediate moment, causes helper to work longer, harder and feel even more despair when they go home at the end of the day, while their client is still in some level of distress.

This overworking, over giving and over caring is what can put you on the fast track to Compassion Fatigue and Burnout.

I encourage each person I work with to create a statement they can tell themselves when they feel hurt because they cannot fix all their client’s problems in the moment.

My statement has varied over the years, but is generally something like this,

“I did not single-handedly create the society that has put this person, in front of me, in this situation.  I will not single-handedly be able to heal and solve this person’s problem.  I will do my absolute best with what I have and trust that the universe will take care of the rest.”

This is why spirituality is such strong protective factor for Compassion Fatigue and Burnout. Spirituality gives you the sense that there is more in this world that just individual people and provides a framework of beliefs about why things are as they are.

I trust that I play a role in many people’s lives.  I also trust that I am not the only one and that others will as well.  This statement and belief system has kept me safe from breaching my own self-care boundaries numerous times.

I know a statement like this can seem controversial or harsh to some people.  What are your thoughts?  How do you make sense of the pain and suffering you see as a helper while still keeping your health protection.  Please let me know in the comments below.

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Charlene is a Clinical Social Worker providing mental health counseling for a Family Health Team in Ottawa, Ontario. She is a Compassion Fatigue Specialist and supports helping professionals move from Compassion Fatigue to Compassion Satisfaction through workshops, coaching and an online eCourse at http://www.charlenerichardrsw.com.

          
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Health

How To Win America’s Fight Against The Opioid Epidemic

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Every day, an astonishing 115 Americans die from opioid overdoses, according to a 2017 report from the Center for Disease Control and Prevention. Approximately half of these deaths are due to the misuse or abuse of prescription opioid painkillers (such as Vicodin, Oxycontin, and morphine). Beyond that, increasingly, deaths come from overdoses of the illicit drugs heroin and fentanyl, which are often used after people become addicted to or misuse prescription opioids.

Each day, more than 1000 people are sent to the emergency room for prescription opioid misuse. In many of these cases, opioids were used along with alcohol or medications meant to treat anxiety or seizures (such as Xanax, Ativan, and Valium). When people ingest such mixtures, they face a heightened risk of injury or death as their breathing slows or stops.

Effective treatments exist. But as treatment for over-dosing is increasingly available, treatment for addiction is still not accessible to many of those who need it. Access to effective treatments for opioid addiction is the missing piece in America’s unsteady fight against the opioid epidemic.

Success in Fighting the Opioid Epidemic

Gains in the fight against the opioid epidemic have been made on several fronts. The physicians and nurse practitioners who prescribe America’s medications are being trained to be more judicious in their use of opioids to treat pain. They are also learning to consider, whenever possible, non-opioid medications and other treatments that don’t come from a pharmacy at all. National guidelines have been established for methods of relieving surgical, cancer-related, and chronic pain without opioids. Taken together, all these efforts are saving lives and reducing the volume of prescription opioids that can be diverted to illicit uses.

Similarly, emergency first responders and trained laypeople now have tools to help prevent deaths from opioid overdoses. Lives have been saved in many communities by the administration of naloxone – a medication which blocks the effects of opioids on breathing centers and reverses overdoses.

But what happens after emergencies – or to prevent them? Treatments for addiction can reduce the likelihood that people addicted to opioids will overdose and die. And such treatments are vital because, like any other chronic illness such as diabetes or heart disease, untreated addiction becomes more severe and resistant to treatment over time.

The Missing Piece – Access

What most of America is sorely missing, however, is sufficient access to the addiction treatments that are the most effective – and not enough efforts are currently underway to increase such access. Currently, the best estimates suggest that only one out of every ten patients seeking drug abuse treatment can actually get into a program. To sharply reduce U.S. opioid deaths, proven forms of treatment should be readily available, on demand, to all who need them. Policymakers, civic leaders, patient advocates, and journalists, should consider the following steps:

  • Treatment and reimbursements should be evidence-based. Research shows that the most effective approach is medication-assisted therapy (MAT), where patients are given methadone, buprenorphine, or naltrexone, alongside therapy to combat addiction. Too many private payers pay for treatments based on mistaken ideas. For example, detoxification is known to be highly ineffective against opioid addiction, yet it is widely practiced and reimbursed.
  • Insurance and other reimbursement systems need to acknowledge that addiction is a chronic disease that almost never goes into remission after a one-time treatment. Treatment for addiction needs to be ongoing and long-term, just like treatments for diabetes or heart disease. But currently most health insurance companies will only cover one treatment episode or a fixed number of treatment days per year.
  • Early, intensive treatment is the most effective and less costly over time. Currently, most insurance companies will only cover outpatient treatment for opioid addiction, and will only reimburse intensive inpatient treatment if the first effort fails. Evidence shows that in many cases, the opposite approach would work better: start with intensive treatment rather than with minor steps that allow time for the disease to progress.
  • Many opioid addicts could be treated within America’s current primary care systems. Two effective medications, buprenorphine and naltrexone, can be prescribed by primary care providers. With appropriate waivers, for instance, a physician can treat up to 100 patients with buprenorphine.
  • Medications need to be supplemented with therapy. Because most primary care clinicians do not have the resources or practice partners to provide the therapies patients need in addition to medications, they often limit the number of addicts they treat or avoid treating them altogether. The answer lies in making behavioral health providers more readily available to work with primary care providers, who could then prescribe effective medications more readily.
  • Patients brought to hospitals for opioid addiction and overdose should be enrolled in therapy and other treatment on the spot. Many patients with opioid addiction end up in hospitals and emergency rooms. The current approach is to stabilize them medically and then tell them, as they are discharged, to seek further treatments. But many do not follow up or have adequate access to the help they need. A better approach would be to start treatment while addicts in crisis are at the hospital – and directly transfer them to an addiction treatment facility upon discharge.
  • Jails and prisons are other places where opioid addicts need treatment. Efforts to bring medication-assisted therapy to the incarcerated could mitigate the larger opioid crisis – and also reduce the rate at which ex-inmates commit new offenses and cycle back to prison.

The bottom line is clear: Increasing access to proven treatments for all addicts who need them would save and improve countless lives, and effectively counter America’s current opioid crisis.

Read more in Peggy Compton and Andrew B. Kanouse, “The Epidemic of Prescription Opioid Abuse, the Subsequent Rising Prevalence of Heroin Use, and the Federal Response” Journal of Pain and Palliative Care Pharmacotherapy 29, no. 2 (2015): 102-114.

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Immigration

Emotions and Politics: A Social Work Response to the Mental Health of Immigrants

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Some of my clients have called their immigration journey, the immigration nightmare. One noted, “everyone talks about the American dream but nobody talks about the American nightmare.” This nightmare has become a real every day experience for many of them.

Children crying and terrified after a stranger, an immigration agent, separates them from their parents when they arrive at the US border. Young adults living in limbo in a life that feels uncertain to them, not knowing whether in a few years they will continue working where they are or studying their university programs because of the nature of their temporary Deferred Action for Childhood Arrivals (DACA).

Parents worrying that if they get deported to their countries of origin their children will become foster kids because they will have to make a hard choice to leave them behind in the United States rather than to bring them back to countries plagued by violence, poverty, and hunger. Scholar and social worker Dr. Luis H. Zayas refers to these children, impacted by immigration policies of family separations, as the forgotten citizens.

These are just of the few stories that represent the plight that immigrants who are undocumented or have temporary status face in the United States. In the last year, we have seen increased political efforts to seize migration and punish immigrants who chose to migrate in the only way they could, creating feelings of insecurity, trauma, depression among community members affected by these policies.

As social workers, it’s crucial we become well-versed on the challenges that existing immigrants and a new generation of newcomers face and that we follow our National Association of Social Workers (NASW) code of ethics to support them and treat them with dignity and worth of a person regardless of how they arrived to this country, nor our political views.

Going Beyond the Headlines, Facts about Immigration

Over the last year, we have been inundated with countless stories of immigrants arriving in record numbers through the Mexican border. Some of the media stories have focused on the illegality of migrating through the border; other outlets have reported on the reasons why immigrants are knocking on our doors but with little emphasis on why immigrants “choose” to come through the border. Reasons for coming include fleeing violence, political unrest, and persecution among others.

From testimonials of lawyers, service providers, and human and immigrant’s rights organizations who are working profusely on the ground at border towns, we know that most of the immigrants who are arriving can qualify as refugees. Noting this difference is important because refugees seeking asylum have a right to seek asylum in the United States and have certain protections. The UN Refugee Agency defines refugee as “someone who has been forced to flee his or her country because of persecution, war or violence. A refugee has a well-founded fear of persecution for reasons of race, religion, nationality, political opinion or membership in a particular social group. Most likely, they cannot return home or are afraid to do so. War and ethnic, tribal and religious violence are leading causes of refugees fleeing their countries,” (UN Refugee Agency, 2019).

We often hear questions like “Why can’t they come the right away?” or “They need to get in line?” The reality is that our immigration system is broken. To come to the United States legally, individuals have to either have a family member who is a Citizen or US Resident petition for them, or be sponsored by an employer through a work visa, most employment visas are usually for high skilled workers, or apply to a lottery system, for the “lucky” opportunity to obtain a visa. It sounds simple, right? Just apply and you should be fine. Not so much!

There is a restriction of the numbers of visas granted each year. According to the Migration Policy Institute, there are about 140,000 work visas per year and family sponsored preferences are limited to 226,000 visas per year. There are currently two types of backlogs impacting the issuance of US Resident cards, which allows people to come to the United States and stay permanently.

“The first is due to visa availability, not enough to go around and meet the demand. The second is due to processing delays of applicants’ documents. A brief illustration of that is that in February 2019, the U.S. government was still processing some family-sponsored visa applications dating to August 1995, and some employment-related visa applications from August 2007,” (Migration Policy Institute, 2019).

This means that a mother who is concerned that gang members have infiltrated her neighborhood, and are looking to extort her each month for a sum of money that she does not have or she and her family will be killed, who may not have a US Resident or Citizen family member or an employer to sponsor her, has no other way to enter the United States as a refugee seeking asylum. She and scores of others do not have another choice.

Clinical Implications

When working with immigrants is important to remember that while there are some similarities in the immigration journey for some, not two stories are alike. This is our opportunity to allow the client to be the expert of their story and have them guide us in their experience.

Community members who are in the United States without an immigration status or a temporary status or are seeking status may face many challenges as they adjust to a new environment or simply work towards surviving it. But their distress or trauma may not be new or their first trauma. Clinical psychologist Dr. Cecilia J. Falicov reminds us of the pre-trauma, during trauma and post-trauma immigrants can experience during their journey. Trauma sometimes begins before people leave their countries of origin. Understanding what their experience was prior to coming to the United States is critical during clinical or initial assessment or throughout work with clients.

Immigrants may experience trouble with acculturation, getting used to new norms, traditions, food, and language. Most importantly and often overlooked is the grief and loss they may experience for having left (or lost) a place they knew, friends, family members and things they are familiar to.

Aside from the trauma, kids who are separated from their parents may experience, attachment to their parent or caregiver may suffer, making it harder for them to have a healthy reunification at a later time.

Furthermore, immigrants may face discrimination, racial profiling or bullying in their community, at work or school, which can lead to stigma about immigration status or passing to hide their immigration status. They can experience abuse at work or exploration, such as earning low wages while working long hours. Perpetrators of abuse can threaten victims who are undocumented to call immigration authorities on them. Often times victims do not call for help out of fear of being deported and what they may not know is that there are actually certain protections for victims of violence or crime who are undocumented.

Immigrants may realize the limitations of their immigration status such as not being able to obtain driving licenses (some states do grant licenses to immigrants who are undocumented), not being able to obtain in-state tuition (some states have passed in-state tuition laws for students who are undocumented), not being able to travel and little or no access to services, resources or benefits.

These and other challenges can lead to depression, anxiety and post-traumatic stress disorder (PTSD), which are the three main diagnoses that impact immigrants. And media news about immigration policies that may impact their life may exuberate symptoms.

While someone’s immigration status can represent a social determinant of health, not all immigrants want to address challenges regarding their status in their work with social workers right away or sometimes ever. Teenage immigrants sometimes just want to talk about dating; parents want to talk about parenting, DACA recipients want to talk about their dreams and aspirations. We must be mindful and respect the client’s self-determination and not impose our own agenda to address what we think the client “should” address and meet the client where they are at in their journey.

The Social Work Response
I propose a comprehensive approach to meeting the needs of our immigrant clients composed of clinical, psychoeducation or supportive services, mezzo (support groups) and advocacy. In my work with immigrant clients whose goal is to address their distress connected to their immigration status, I use a psychoeducational, skills building and processing approach where I incorporate:

Psychoeducation on the impact of politics in everyday life such as anxiety, depression, and PTSD; identifying feelings, emotions, behaviors, thoughts, and overall mental health symptoms.

Processing emotions, verbalization of feelings, normalization and validation through empathy, reflective listening, etc.

Skills building including stress and anxiety management, behavioral activation to combat depression, self-care, cognitive behavioral therapy, mindfulness (focusing on present moment and grounding). Strengths assessment and positive qualities. This activity entails helping clients re-discover or discover their strengths by reviewing all they have accomplished so far, including getting here. For many, the journey of getting here is a demonstration of determination, risk-taking, and survivorship.

Fostering a sense of safety, building safety plan (to address fears like “what if I get deported,” etc.)

Empowerment: gaining control over what we can control.

Building Awareness: providing know your rights information, connecting clients to local resources, and providing information analysis.

In addition to the work we can do through our own agencies or places of work, effective interventions include providing services for community members at their schools, churches, and community based organizations.

This requires us to partner with entities and cross collaborate. Not too long ago, several colleagues and I were going to schools to talk to immigrant parents about stress management. The local school system and the organization I worked at then formed a partnership to bring awareness during “drop off kids and coffee time.”

The clinical response and mezzo responses are just some ways of helping clients address their distress. But we know that our client’s distress is connected to environmental issues and as long as there isn’t a solution to that can aid the millions of lives impacted by the broken immigration system, our immigrant community currently in limbo will continue to suffer. This is when micro becomes macro. We have plenty of opportunities to engage right now on important fights including the passage of the DREAM and PROMISE ACT and decrying the family separations that are impacting children and are a form of children neglect and abuse. This is when we join together to fight for social justice as our NASW code of ethics calls us to do.

REFERENCES

Falicov, C. J. (2014). Latino families in therapy (2nd ed.). New York, NY: The Gilford Press.

Zayas, L. H. (2015). Forgotten citizens: deportation, children and the making of american exiles and orphans. New York, NY: Oxford University Press.

Zong, J., Zong, J. B., Batalova, J., & Burrows, M. (2019, March 14). Frequently Requested Statistics on Immigrants and Immigration in the United States. Retrieved from https://www.migrationpolicy.org/article/frequently-requested-statistics-immigrants-and-immigration-united-states

What is a Refugee? Definition and Meaning. Retrieved March 15, 2019, from https://www.unrefugees.org/refugee-facts/what-is-a-refugee/

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Mental Health

Smartphones Help UB Researcher Better Understand the Nature of Depression and Anxiety

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Decades of research into anxiety and depression have resulted in the development of models that help explain the causes and dimensions of the two disorders.

For all of their well-established utility however, these models measure differences between individuals and are derived from studies designed using few assessments that can be months or even years apart.

In other words, the models are highly informative, but not optimal for examining what’s happening emotionally in a particular person from moment to moment.

Now, a University at Buffalo psychologist is extending that valuable research to repeatedly and frequently measure symptoms of specific individuals, in real time, to learn how immediate feelings relate to later symptoms.

The research casts anxiety and depression in a manner not previously studied and the results suggest that some emotions linger in a way that predicts feelings beyond what’s happening at specific times. This information could provide treatment benefits for patients struggling with the disorders, according to Kristin Gainey, an assistant professor in UB’s psychology department and the study’s author.

“Clinicians aren’t primarily interested in how one person’s symptoms compare to someone else, which is what most studies focus on. Rather, they’re most interested in how to shift the feelings of someone with anxiety or depression. In other words, they want to understand how to change the emotional experiences of a given individual over time and across different situations,” says Gainey, an expert on emotion and affect in mood and anxiety disorders and a recent recipient of one of the American Psychological Association’s Early Career Distinguished Scientific awards. “The only way to get at that directly is to measure these processes repeatedly within a person as they’re happening.”

To do that, Gainey conducted baseline assessments on 135 participants, each of whom were already seeking some kind of psychological treatment.

Three times a day for 10 weeks, the participants received surveys on their smartphones about their feelings and symptoms. They completed the survey within 20 minutes of its arrival.

“That generated enough reports to provide a good sense for each person’s fluctuations and trajectories of symptoms and affect (defined as the objective feeling state that’s part of an emotion),” says Gainey.

A smartphone provides a portrait of immediacy that questionnaires distributed in a lab that summarize feelings over extended periods are unable to achieve.

“We can’t always remember accurately how we felt days and weeks ago, especially if there were some days you felt really bad and other days you felt great,” she says. “That’s not easy to summarize in a single index.”

Anxiety and depression are each unique disorders, but they often appear together in a single patient. Both disorders share high levels of negative emotions, such as fear, sadness, and anger, while low levels of positive emotions, like excitement and interest, are unique to depression.

Gainey says it’s not surprising that particular affective states, like feeling happy or feeling sad, might be responsible for symptoms experienced soon afterward. What researchers don’t know much about is how long those effects tend to persist, and which specific symptoms they lead to hours or days later.

“This study let us see that some effects were short-lived, but for depression, if you were feeling high levels of negative affect, even if we control for how depressed a participant was at that time, it was still predictive of increased depression 24 hours later,” says Gainey.

That might suggest that clinicians could track peoples’ positive and negative affect in real time and plot trajectories that are indicative of increased risk.

“If we can identify specific risk factors for increased symptoms in real time, we could even use smartphones to send suggestions about helpful strategies or alert the person’s mental health care provider,” she says.

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Environmental Justice

Climate Change Increases Potential for Conflict and Violence

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Images of extensive flooding or fire-ravaged communities help us see how climate change is accelerating the severity of natural disasters. The devastation is obvious, but what is not as clear is the indirect effect of these disasters, or more generally of rapid climate change, on violence and aggression.

That is what Craig Anderson sees. The Iowa State University Distinguished Professor of psychology and Andreas Miles-Novelo, an ISU graduate student and lead author, identified three ways climate change will increase the likelihood of violence, based on established models of aggression and violence. Their research is published in the journal Current Climate Change Reports.

Anderson says the first route is the most direct: higher temperatures increase irritability and hostility, which can lead to violence. The other two are more indirect and stem from the effects of climate change on natural disasters, failing crops and economic instability. A natural disaster, such as a hurricane or wildfire, does not directly increase violence, but the economic disruption, displacement of families and strain on natural resources that result are what Anderson finds problematic.

One indirect way natural disasters increase violence is through the development of babies, children and adolescents into violence-prone adults, he said. For example, poor living conditions, disrupted families and inadequate prenatal and child nutrition are risk factors for creating violence-prone adults. Anderson and Miles-Novelo noted these risk factors will become more prevalent as a result of climate change-induced disasters, such as hurricanes, droughts, floods, water shortages and changing agricultural practices for efficient production of food.

Another indirect effect: Some natural disasters are so extensive and long term that large groups of people are forced to migrate from their homeland. Anderson says this “eco-migration” creates intergroup conflicts over resources, which may result in political violence, civil wars or wars between nations.

“This is a global issue with very serious consequences. We need to plan for ways to reduce the negative impacts,” Anderson said. “An inadequate food supply and economic disparity make it difficult to raise healthy and productive citizens, which is one way to reduce long-term violence. We also need to plan for and devote resources to aid eco-migrants in their relocation to new lands and countries.”

Which is worse?

There are no data and there is no method to estimate which of the three factors will be most damaging, Anderson said. The link between heat and aggression has the potential to affect the greatest number of people, and existing research, including Anderson’s, shows hotter regions have more violent crime, poverty, and unemployment.

However, Anderson fears the third effect he and Miles-Novelo identified – eco-migration and conflict – could be the most destructive. He says we are already seeing the migration of large groups in response to physical, economic or political instability resulting from ecological disasters. The conflict in Syria is one example.

Differences between migrants and the people living in areas where migrants are relocating can be a source of tension and violence, Anderson said. As the level of such conflicts escalates, combined with the availability of weapons of mass destruction, the results could be devastating.

“Although the most extreme events, such as all-out war, are relatively unlikely, the consequences are so severe that we cannot afford to ignore them,” Anderson said.  “That is why the U.S. and other countries must make sure these regional conflicts and eco-migration problems don’t get out of hand. One way to do that is to provide appropriate aid to refugees and make it easier for them to migrate to regions where they can be productive, healthy and happy.”

Taking action now

Anderson and Miles-Novelo say the purpose of their research is to raise awareness among the scientific community to work on prevention efforts or ways to limit harmful consequences. The long-term goal is to educate the public on the potential for increased violence.

“From past experience with natural disasters, we should be able to prepare for future problems by setting aside emergency resources and funds,” Miles-Novelo said. “We should tear down negative stereotypes and prejudices about those who will need help and humanely assist refugees and others who are displaced. By doing all these things we can reduce conflict and hostility.”

Changing attitudes and policies about immigration also will lessen the potential for conflict, Anderson said. He points to the backlash against refugees in many European countries.

“The view that citizens of wealthy countries often have about refugees needs to change – from seeing them as a threat to a view that emphasizes humanitarian values and the benefits refugees bring when they are welcomed into the community,” Anderson said.

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Mental Health

The Importance of Finding a Facility That Offers Both Inpatient Drug Rehab and Inpatient Alcohol Rehab

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Navigating life with an addiction to alcohol or drugs can be especially difficult and exhausting. It always feels like the substance is taking over. If it’s not in the foreground dominating life, then it’s in the background, always in the back of your mind. Through treatment at an inpatient alcohol rehab or an inpatient drug rehab, life can finally be different, changing for the better.

Of course, not all rehab facilities are the same. Some offer only outpatient care. With this form of rehab, the enrollee is attending the facility but still going home to their daily life. While outpatient rehab may help some enrollees work through their alcohol or drug addiction, recovery doesn’t always stick.

Inpatient rehab, on the other hand, offers more comprehensive care. That’s because enrollees are at the facility around the clock for a set amount of days (although not in all instances).

Finding a facility with inpatient rehabilitation for alcohol and drug addiction may have seemed impossible until now. However, there are more options now than before. The care administered at the new breed of treatment centers is holistic, meaning there’s more to recovery than simple withdrawal, therapy, and then out the door. Instead, there’s work done to improve the lives of enrollees by nourishing and restoring their spirit, body, and mind.

Those who want to are ready to make a change in their lives may be interested in these inpatient rehabilitation facilities. Here are several reasons inpatient care can be so significant for enrollees looking to become sober.

Inpatient Treatment May Be More Successful Than Outpatient Programs

According to data cited from the National Institute of Alcohol Abuse on Alcoholism, inpatient alcohol rehab may have better sobriety rates than outpatient care. To back up that claim, 303 alcohol rehab enrollees were tracked over five years. Of those 303 enrollees, 120 of them participated in outpatient rehab while the other 183 did an inpatient program.

In the study, enrollees with intact social support systems and in better psychiatric health were proven to do equally well in an outpatient versus inpatient rehab setting. Those with weaker social support and a higher rate of mental illness did better exclusively in inpatient settings.

Regardless of the social support and mental health of enrollees, the National Institute of Alcohol Abuse on Alcoholism discovered that those who were in outpatient rehab programs had a four times higher chance of relapsing into alcohol use over those in an inpatient program.

This could because those in an outpatient rehab program can keep going back to their same old haunts or toxic relationships that provide alcohol, drugs, or other addictive substances. Even though they show up for rehab, if they’re still using when they’re home, a vicious cycle repeats itself. True recovery becomes practically impossible.

Whether it’s for inpatient alcohol rehab or inpatient drug rehab, then, a facility with comprehensive inpatient care is best.

Alcohol and Drug Addiction Are Not Alike

Those who are addicted to alcohol will not necessarily need to go through the same treatment modalities as those with a drug addiction, and vice-versa. When a rehab facility only offers treatment for one type of addiction over another, it gets easy for an enrollee to be pigeonholed.

For example, perhaps an enrollee with an alcohol addiction enters a drug rehab center because it’s conveniently close to them or it’s more affordable. They figure that an addiction is an addiction and they’ll come out on the other side sober.

Without special attention and focus on what factors created the addiction in the first place as well as individualized care, it’s unlikely the rehab will work. It’s much better for someone who’s addicted to alcohol to receive inpatient alcohol rehab and someone who is addicted to drugs to get their own care at an inpatient facility.

Looking for Inpatient Rehabilitation Facilities for Alcohol or Drug Addiction?

Whether addicted to alcohol, drugs, or even both, getting the right help at inpatient rehabilitation facilities is crucial. QUality programs will provide both inpatient and outpatient care to treat addiction. Through this comprehensive, holistic approach, which combines medically-supervised withdrawals, therapy modalities, physical exercise, improved diet, meditation, and more can renew an enrollee’s entire being.

We don’t put a limit on the length of our inpatient care, either. While some patients will stay at an inpatient program for 30 days, others will need more time. A quality inpatient addiction center is willing to work with those enrollees for as long as it takes to make a return to a healthy, addiction-free life.

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Mental Health

The More the Merrier? Children with Multiple Siblings More Susceptible to Bullying

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A child with more than one brother or sister is more likely to be the victim of sibling bullying than those with only one sibling, and firstborn children and older brothers tend to be the perpetrators, according to research published by the American Psychological Association.

“Sibling bullying is the most frequent form of family violence and it is often seen as a normal part of growing up by parents and health professionals, but there is increasing evidence that it can have long-term consequences, like increased loneliness, delinquency and mental health problems,” said Dieter Wolke, PhD, of the University of Warwick and lead author of the study. It was published in the journal Developmental Psychology.

Wolke and his co-author, Slava Dantchev, B.Sc., also of the University of Warwick, wanted to understand the underlying causes of sibling bullying and examined the possible impact of family structure, parenting behaviors, early social experiences and a child’s temperament.

The researchers analyzed data from a longitudinal study of 6,838 British children born in either 1991 or 1992 and their mothers. They defined sibling bullying as psychological abuse (e.g., saying nasty or hurtful things), physical abuse (e.g., hitting, kicking or pushing) or emotional abuse (e.g., ignoring one’s sibling, telling lies or spreading false rumors). The kids were put into four categories: victims, bully victims (defined as being both a perpetrator and victim of bullying), bullies or uninvolved.

When the children were 5 years old, their mothers reported how often the children were victims or perpetrators of bullying in the household. Sibling relations were analyzed two years later when the mothers were asked how much time the children spent engaging with their siblings on various activities, such as crafts or drawing. Several years later, at age 12, the children reported if they had been bullied by a sibling or if they had bullied a sibling within the previous six months. The boys and girls were also asked their ages when they first experienced sibling bullying and when they first bullied a sibling.

Researchers also collected family statistics from the mothers, including the number of children living in the household, the mother’s marital status, the family’s socioeconomic background, maternal mental health during and after pregnancy, parental conflicts, domestic violence and child abuse and the mother-child relations. They also assessed each child’s temperament, mental health, IQ and social/emotional intelligence at various points during their early years.

Approximately 28 percent of the children in the study were involved in sibling bullying and psychological abuse was the most common form. The majority of those children were found to be bully victims, meaning they bullied and were bullied, according to the study.

“Bullying occurs in situations where we cannot choose our peers, like in families,” said Wolke. “Siblings live in close quarters and the familiarity allows them to know what buttons to press to upset their brothers or sisters. This can go both ways and allows a child to be both a victim and a perpetrator of bullying.”

Family structure and gender were the strongest predictors of sibling bullying by middle childhood, according to the authors.

“Bullying was more likely to occur in families with three or more children and the eldest child or older brothers were more often the bullies,” said Dantchev. “Female children and younger children were more often targeted.”

Wolke and Dantchev believe bullying can happen in larger families because resources such as parental affection or attention and material goods are more limited.

“Despite our cultural differences, humans are still very biologically driven. A firstborn child will have their resources halved with the birth of a sibling, and even more so as more siblings are added to the family,” said Wolke. “This causes siblings to fight for those limited resources through dominance.”

Although the researchers investigated whether marital and socioeconomic status would be associated with more or less bullying, they did not find any evidence.

“Sibling bullying does not discriminate. It occurs in wealthy families just as much as lower-income families and it occurs in single-parent households just as much as two-parent households,” said Wolke.

These findings may be helpful to parents as they welcome new additions to their families, Wolke said.

“It will be important for parents to realize and understand that resource loss can affect an older child,” he said. “It is a good idea for parents to manage this from the beginning by spending quality time with their firstborn or older children and by involving them in caring for younger siblings.”

Article: “Trouble in the Nest: Antecedents of Sibling Bullying Victimization and Perpetration” by Slava Dantchev, B.Sc., and Dieter Wolke, PhD, University of Warwick. Developmental Psychology. Published online Feb. 14, 2019.

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