Covering specific techniques for the treatment of Internet addiction.

The hardest issue to overcome in terms of treatment is breaking through an Internet addict's denial of the problem. Similar to alcoholism, the Internet addict must first realize the addiction and be motivated to seek help.

Many people believe the only way to cure Internet addiction is to pull the plug, cut the modem wire, or throw out the computer. But think again. You don't have to go "cold turkey" in order to deal with this disorder. Since the Internet is a productive tool when used properly, it important to find a balance between Internet use and other life activities. The treatment model is similar for eating disorders or controlled drinking programs. The focus being to identify triggers which onset binge-behavior and re-learning how to use it in moderation.

Unlike physical addictions like alcoholism, Internet addiction does not require abstinence for a healthy and life-enhancing recovery. To help in that recovery process, the book "Caught in the Net" provides practical tools and dozens of intervention techniques. Special emphasis is given to additional outside resources that are becoming available to treat this addiction and which can help Internet junkies stay on track in the months and years ahead.

Techniques for the Treatment of Internet Addiction

1. Practicing the opposite: The goal of this exercise is to have patients disrupt their normal routine and re-adapt new time patterns of use in an effort to break the on-line habit.
2. External stoppers: Use concrete things that the patient needs to do or places to go as prompters to help log off. If the patient has to leave for work at 7:30 am, have him or her log in at 6:30, leaving exactly one hour before its time to quit.
3. Setting goals: Many attempts to limit Internet usage fail because the user relies on an ambiguous plan to trim the hours without determining when those remaining on-line slots will come. In order to avoid relapse, structured sessions should be programmed for the patient by setting reasonable goals, perhaps 20 hours instead of a current 40. Then, schedule those twenty hours in specific time slots and write them onto a calendar or weekly planner.
4. Abstinence: If a specific application, such as chat or a game, has been identified and moderation of it has failed, then abstinence from that application is the next appropriate intervention.
5. Reminder cards: To help the patient stay focused on the goal of either reduced use or abstinence from a particular application, have the patient make a list on 3x5 cards of the (a) five major problems caused by addiction to the Internet, and (b) five major benefits for cutting down Internet use or abstaining from a particular application. Instruct patients to take out the index card as a reminder of what they want to avoid and what they want to do for themselves when they hit a choice point when they would be tempted to use the Internet instead of doing something more productive or healthy.

1. Personal inventory: The clinician should instruct the patient to make a list of every activity or practice that has been neglected or curtailed since the on-line habit emerged. This exercise will help the patient become more aware of the choices he or she has made regarding the Internet and rekindle lost activities once enjoyed.
2. Support groups: Support groups tailored to the patient's particular life situation will enhance the patient's ability to make friends who are in a similar situation and decrease their dependence upon on-line cohorts/friends. If an Internet addict resorts to going online because they are lonely, then encourage them to join a church group, bowling league, etc.
3. Family therapy: may be necessary among Internet addicts whose marriages and family relationships have been disrupted and negatively influenced by Internet addiction

Please view our array of Services at the Center for Internet Addiction Recovery. If you are an addiction counselor, employee assistance provider, family therapist, or mental health professional who would like to arrange a full-day training workshop on the evaluation and treatment of compulsive Internet use, please contact us here.

Please contact our Virtual Clinic if you think you have a problem with controlling your Internet use (or you know someone who does).

If you are a therapist treating a client with signs of compulsive Internet use, please take our Survey for Therapists.

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Fact sheet covering research findings on effective treatment approaches for drug abuse and addiction.

Drug addiction is a complex but treatable brain disease. It is characterized by compulsive drug craving, seeking, and use that persist even in the face of severe adverse consequences. For many people, drug addiction becomes chronic, with relapses possible even after long periods of abstinence. In fact, relapse to drug abuse occurs at rates similar to those for other well-characterized, chronic medical illnesses such as diabetes, hypertension, and asthma. As a chronic, recurring illness, addiction may require repeated treatments to increase the intervals between relapses and diminish their intensity, until abstinence is achieved. Through treatment tailored to individual needs, people with drug addiction can recover and lead productive lives.

The ultimate goal of drug addiction treatment is to enable an individual to achieve lasting abstinence, but the immediate goals are to reduce drug abuse, improve the patient's ability to function, and minimize the medical and social complications of drug abuse and addiction. Like people with diabetes or heart disease, people in treatment for drug addiction will need to change behavior to adopt a more healthful lifestyle.

In 2004, approximately 22.5 million Americans aged 12 or older needed treatment for substance (alcohol or illicit drug) abuse and addiction. Of these, only 3.8 million people received it. (National Survey on Drug Use and Health (NSDUH), 2004 )

Untreated substance abuse and addiction add significant costs to families and communities, including those related to violence and property crimes, prison expenses, court and criminal costs, emergency room visits, healthcare utilization, child abuse and neglect, lost child support, foster care and welfare costs, reduced productivity, and unemployment.

The latest estimate for the costs to society of illicit drug abuse alone is $181 billion (2002). When combined with alcohol and tobacco costs, they exceed $500 billion including healthcare, criminal justice, and lost productivity. Successful drug abuse treatment can help reduce this cost; crime; and the spread of HIV/AIDS, hepatitis, and other infectious diseases. It is estimated that for every dollar spent on addiction treatment programs, there is a $4 to $7 reduction in the cost of drug-related crimes. With some outpatient programs, total savings can exceed costs by a ratio of 12:1.

Basis for Effective Drug Addiction Treatment

Scientific research since the mid-1970s shows that drug treatment can help many people change destructive behaviors, avoid relapse, and successfully remove themselves from a life of substance abuse and addiction. Recovery from drug addiction is a long-term process and frequently requires multiple episodes of treatment. Based on this research, key principles have been identified that should form the basis of any effective treatment program:

• No single treatment is appropriate for all individuals.
• Treatment needs to be readily available.
• Effective treatment attends to multiple needs of the individual, not just his or her drug addiction.
• An individual's treatment and services plan must be assessed often and modified to meet the person's changing needs.
• Remaining in treatment for an adequate period of time is critical for treatment effectiveness.
• Drug addiction counseling and other behavioral therapies are critical components of virtually all effective treatments for addiction.
• For certain types of disorders, medications are an important element of treatment, especially when combined with counseling and other behavioral therapies.
• Addicted or drug-abusing individuals with coexisting mental disorders should have both disorders treated in an integrated way.
• Medical management of withdrawal syndrome is only the first stage of addiction treatment and by itself does little to change long-term drug use.
• Treatment does not need to be voluntary to be effective.
• Possible drug use during treatment must be monitored continuously.
• Treatment programs should provide assessment for HIV/AIDS, hepatitis B and C, tuberculosis, and other infectious diseases, and should provide counseling to help patients modify or change behaviors that place themselves or others at risk of infection.
• As is the case with other chronic, relapsing diseases, recovery from drug addiction can be a long-term process and typically requires multiple episodes of treatment, including "booster" sessions and other forms of continuing care.

Effective Treatment Approaches

Medication and behavioral therapy, alone or in combination, are aspects of an overall therapeutic process that often begins with detoxification, followed by treatment and relapse prevention. Easing withdrawal symptoms can be important in the initiation of treatment; preventing relapse is necessary for maintaining its effects. And sometimes, as with other chronic conditions, episodes of relapse may require a return to prior treatment components. A continuum of care that includes a customized treatment regimen, addressing all aspects of an individual's life, including medical and mental health services, and followup options (e.g., community- or family-based recovery support systems) can be crucial to a person's success in achieving and maintaining a drug-free lifestyle.

Medications can be used to help with different aspects of the treatment process.

Withdrawal: Medications offer help in suppressing withdrawal symptoms during detoxification. However, medically assisted withdrawal is not in itself "treatment"—it is only the first step in the treatment process. Patients who go through medically assisted withdrawal but do not receive any further treatment show drug abuse patterns similar to those who were never treated.

Treatment: Medications can be used to help re-establish normal brain function and to prevent relapse and diminish cravings throughout the treatment process. Currently, we have medications for opioid (heroin, morphine) and tobacco (nicotine) addiction, and are developing others for treating stimulant (cocaine, methamphetamine) and cannabis (marijuana) addiction.

Methadone and buprenorphine, for example, are effective medications for the treatment of opiate addiction. Acting on the same targets in the brain as heroin and morphine, these medications block the drug's effects, suppress withdrawal symptoms, and relieve craving for the drug. This helps patients to disengage from drug-seeking and related criminal behavior and be more receptive to behavioral treatments.

Buprenorphine: This is a relatively new and important treatment medication. NIDA-supported basic and clinical research led to the development of buprenorphine (Subutex or, in combination with naloxone, Suboxone), and demonstrated it to be a safe and acceptable addiction treatment. While these products were being developed in concert with industry partners, Congress passed the Drug Addiction Treatment Act (DATA 2000), permitting qualified physicians to prescribe narcotic medications (Schedules III to V) for the treatment of opioid addiction. This legislation created a major paradigm shift by allowing access to opiate treatment in a medical setting rather than limiting it to specialized drug treatment clinics. To date, nearly 10,000 physicians have taken the training needed to prescribe these two medications, and nearly 7,000 have registered as potential providers.

Behavioral Treatments help patients engage in the treatment process, modify their attitudes and behaviors related to drug abuse, and increase healthy life skills. Behavioral treatments can also enhance the effectiveness of medications and help people stay in treatment longer.

Outpatient behavioral treatment encompasses a wide variety of programs for patients who visit a clinic at regular intervals. Most of the programs involve individual or group drug counseling. Some programs also offer other forms of behavioral treatment such as:

• Cognitive Behavioral Therapy, which seeks to help patients recognize, avoid, and cope with the situations in which they are most likely to abuse drugs.
• Multidimensional Family Therapy, which addresses a range of influences on the drug abuse patterns of adolescents and is designed for them and their families.
• Motivational Interviewing, which capitalizes on the readiness of individuals to change their behavior and enter treatment.
• Motivational Incentives (contingency management), which uses positive reinforcement to encourage abstinence from drugs.

Residential treatment programs can also be very effective, especially for those with more severe problems. For example, therapeutic communities (TCs) are highly structured programs in which patients remain at a residence, typically for 6 to 12 months. Patients in TCs may include those with relatively long histories of drug addiction, involvement in serious criminal activities, and seriously impaired social functioning. TCs are now also being designed to accommodate the needs of women who are pregnant or have children. The focus of the TC is on the re-socialization of the patient to a drug-free, crime-free lifestyle.

Treatment within the criminal justice system can succeed in preventing an offender's return to criminal behavior, particularly when treatment continues as the person transitions back into the community. Studies show that treatment does not need to be voluntary to be effective. Research from the Substance Abuse and Mental Health Services Administration suggests that treatment can cut drug abuse in half, reduce criminal activity up to 80 percent, and reduce arrests up to 64 percent.*

Source: National Institute on Drug Abuse

NOTE: This is a fact sheet covering research findings on effective treatment approaches for drug abuse and addiction. If you are seeking treatment, please call 1-800-662-HELP(4357) for information on hotlines, counseling services, or treatment options in your State. This is the Center for Substance Abuse Treatment's National Drug and Alcohol Treatment Service. Drug treatment programs by State also may be found online at www.findtreatment.samhsa.gov.

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Study after study has shown that Asians underutilize mental health services much more than other populations, according to Stanley Sue, PhD, director of the National Research Center on Asian American Mental Health in Davis, California.

It's a trend that Dr. Sue discovered in the seventies when he was a graduate student intern at the University of California, Los Angeles Psychiatry Clinic. The clinic assessed information on the number of Asian student clients, as well as therapists' impressions of those clients.

"Not only did we find that Asians underutilized services," Dr. Sue said. "We also found that the Asian students exhibited more severe mental disturbances than the non-Asian students."

The same patterns can be seen today. The National Research Center evaluated records of thousands of clients of the Los Angeles County mental health system for a six-year period. "What we found," said Dr. Sue, "was that Asians were underrepresented in the outpatient system, and they were more likely than African Americans, Whites, and Hispanics to have psychotic disorders."

Contrary to popular belief, the fact that a certain population is not using mental health services does not indicate that the population is free of mental health problems, Dr. Sue added.

A key question then is why? Why aren't Asians seeking and receiving treatment from state services if their mental health needs are so significant? Several factors play into why people use or don't use mental health services, including the ease of accessing services and willingness to seek help. According to experts, culture is at the heart of such factors.

"For example, in traditional Chinese culture, many diseases are attributed to an imbalance of cosmic forces--yin and yang," Dr. Sue explained. "So the goal is to restore the balance, and that might be accomplished through exercise or diet," and not necessarily through a mainstream mental health system.

While there are cultural attitudes that can be seen across the Asian population, there are important differences between groups, according to Deborah S. Lee, CSW, director of Asian American Mental Health Services in New York City.

"For all Asian groups, there is a stigma attached to going to an outsider to obtain treatment for mental health problems," Ms. Lee said. "But depending on the group, the stigma is expressed differently." This also can depend on educational background and how long a person has been in this country.

Ms. Lee's Chinese clients often interpret mental illness as punishment for some wrongdoing carried out by themselves, by their family members, or by their ancestors. For this reason, they may feel ashamed to seek or participate in treatment.

People in the Chinese community often call Ms. Lee's clinic to say they have a friend who is experiencing some problems. After telling the caller to bring in the friend, she frequently discovers that the friend is really a relative of the person who called. "The caller was simply ashamed of having such problems in the family," she said.

For Asians, the individual is commonly viewed as a reflection of the entire family. "That's why the family should be included in treatment," Lee suggests.

In the case of a Cambodian woman who suffers from depression, her husband is against her receiving treatment from Lee's clinic. "He believes she has mental health problems because she is haunted by evil spirits," Ms. Lee said. "So we had to work on convincing him to keep letting us treat her here, while they also use cultural practices at home to ward off bad spirits. We had to let him know that we could include him in the process of developing a treatment plan for his wife. We also had to make sure that each practice would not interfere with the other."

Ms. Lee finds that because the Korean community is very religious, her Korean clients often confuse their hallucinations with spiritual voices. "Our Korean clients also rely very heavily on treating themselves with medication. We have to educate them and their families about the dangers of misusing drugs and the importance of understanding that treatment for mental health problems involves more than just medication." Lee also treats Japanese clients, who are very concerned about who knows that they are in treatment. Many people have failed to show up for appointments for fear of being seen. "Sometimes, we block in an extra 15 minutes between appointment so that there is less of a chance that people might run into someone they know," Lee noted.

Asian American Mental Health Services, a state-licensed program, is specifically designed for the New York Asian community. The program operates a Chinese unit, which has a continuing treatment program for patients who are chronically mentally ill. There is also a Japanese unit, a Korean unit, and a Southeast Asian unit, all with outpatient clinics.

Ms. Lee and her staff are Asian, and they possess specialized knowledge and skills about delivering mental health services to Asians. They know, for instance, that when a client comes in complaining of an inability to move a part of the body, it's important to conduct a culturally-sensitive psychological evaluation, rather that automatically sending the client away for a physical check-up. "It's very common among Asians," Ms. Lee said, "to report physical problems that are really a reflection of mental or emotional problems."

But what about those mainstream clinics that don't have insight into Asian culture? How can services be reorganized so that Asians can be treated there? According to Dr. Sue, mental health workers need to be trained on aspects of Asian culture, and mainstream facilities should make use of Asian consultants.

"Another valuable strategy," he added, "is targeting Asians through community education." It is possible to modify attitudes this way. Important points to make are that talking with others about problems can help, that early identification is crucial, and that providers are required to keep problems confidential.

next: Depression in Racial / Ethnic Minorities
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female sexual problems

A man's capacity to get and maintain an erection decreases gradually as he ages, while most women require more than penile penetration to reach orgasm.

The penis shape and erection angle vary from man to man - there is no normal shape or size and the average erection is roughly horizontal from the body.

Most men cannot reach orgasm more than once in about an hour and most have between one and four orgasms per week, depending on their age. Men don't 'come in buckets' - usually they ejaculate about a teaspoon-full upon climax.

Most women require more than penile penetration to reach orgasm - 'thrusting' alone is usually not enough - clitoral stimulation and foreplay are usually more important.

A woman's natural lubrication cannot be turned on like a tap - it needs desire, stimulation and a little time, and on those occasions when the woman is 'drier' than usual, a water-based artificial lubricant is a normal adjunct to enjoyable lovemaking.

Some of the most important discoveries sexual partners can make about each other during sex is through talking - finding out what excites and arouses them, what are turn-offs, what are fears and anxieties, what are fantasies, how vigorous their sex could be.

Find out about each other and take sex further by having a shared knowledge about the kind of sensual lovemaking that appeals to you both. Sexual and emotional needs vary from person to person - some people are happy in monogamous relationships, others have a desire for more than one partner.

Masturbation in front of your partner (with her/his agreement and encouragement) or together (mutual masturbation) can be a turn-on for both partners and is a valid and very enjoyable part of lovemaking.

next: Men and Sex Homepage

Recognition of eating disorders as real and treatable diseases is critically important. The consequences of eating disorders can be severe. For example, one in ten cases of anorexia nervosa leads to death from starvation, cardiac arrest, kidney failure, other medical complications, or suicide.

Without treatment, up to twenty percent (20%) of people with serious eating disorders die. However, early identification and treatment leads to more favorable outcomes. With treatment, the mortality rate falls to two to three percent (2-3%).

Getting Help

Parents who notice symptoms of an eating disorder in their teenagers should ask their family physician or pediatrician for a referral to a child and adolescent mental health professional.

With comprehensive treatment, most teenagers can be relieved of the symptoms or helped to control eating disorders. Mental health professionals that specialize in working with children and adolescents are trained to evaluate, diagnose, and treat these psychiatric disorders. Eating disorders frequently co-occur with depression, substance abuse, and anxiety disorders, and it is important to recognize and get appropriate treatment for these problems as well.

Treatment for eating disorders usually requires a team approach; including individual therapy, family therapy, working with a primary care physician, and working with a nutritionist.

Treatment usually begins in an outpatient setting, but an eating disorder treatment  center may be necessary if symptoms are severe.

• Hospitalization may be necessary if there is:
• significant weight loss
• low blood pressure
• cardiac dysfunctions
• fluid retention
• dehydration
• electrolyte disturbances
• inability to function at home, school, and the community
• severe depression
• thoughts of suicide

If the hospital is not exclusive to the treatment of eating disorders, the individual should then be transferred to an eating disorders residential treatment center specializing in eating disorders that addresses underlying psychological issues and provides a safe, secure, loving, and supportive environment.

Information from the National Eating Disorders Association, the American Academy of Child & Adolescent Psychiatry, and Anorexia Nervosa and Related Eating Disorders, Inc.

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Hey there mysterious 'net wanderer. Welcome to Peace, Love, and Hope: A Web Site on Eating Disorders. Included here is information not just on anorexia and bulimia, but also on the many other demons that tend to accompany anorexia and bulimia (ie - depression, self-injury, OCD, etc.) Take your time and relax, and as always, let me know if there is anything that I can do for you.=)

Alexandra

...and Alexandra's rants.and.raves

Table of contents:

• About the Author
• Anorexia: Why We Can't "Just Eat'
• Body Dysmorphic Disorder: When the Mirror Lies
• Bulimia: More than 'Ox Hunger'
• Eating Disorders F.A.Q.
• Eating Disorder Treatment Centers and Therapists
• Medical Problems Associated with Anorexia and Bulimia
• Prevention of an Eating Disorder Relapse
• Self-Mutilation: The Truth Behind the Shame
• Articles on Eating Disorders and Others
• Compulsive Exercising
• Depression and Eating Disorders: When Sadness Never Fades
• Eating Disorder Relapses: What to Do and How to Prevent Them
• Eating Disorders Prevention: What You and Others Can Do
• The Truth on Laxatives, etc.
• Obsessive Compulsive Disorder: When Too Much Isn't Enough
• Rules' of Support: What and What NOT to Say
• The Signs of an Eating Disorders Relapse

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The Creation and Collapse of Values

Values and beliefs play an even more complex role in depression than do ordinary goals. For example, Warren H. believes that it is very important that each person dedicate himself or herself to the welfare of the community. But unfortunately he lacks the talent and energy to make a large contribution to the community. When he compares his actual contribution to the contribution he believes one should make, his self-comparison is negative, leading to sadness and depression.

Values are more fundamental than ordinary goals. We can think of values as goals that are based on the individual's deepest beliefs about human life and society, assessments of what is good and what is evil. Even if a person's values are obviously implicated in a depression--for example, the soldier who refuses to kill during a battle, and is therefore judged by other soldiers and himself as unpatriotic and worthless--no one would suggest that he should simply alter for convenience his belief that life is good and killing is bad.

There is nothing irrational about the soldier's thinking or that of Warren H. Nor is there any logical flaw in the thinking of the English cabinet minister John Profumo who courted danger for his country by consorting with prostitutes who were also consorting with a Soviet spy. For his actions, Profumo did penance for ten years in charity work; that choice is not irrational.

Nor is a person irrational who kills a child in an avoidable auto accident and then judges himself harshly because he has contravened his highest value by destroying human life. There is nothing irrational about the subsequent negative self-comparisons between his behavior and his ideal self which result in depression. Indeed, the guilt and depression may be seen as an appropriate self-punishment, similar to the punishment of the person that society may inflict by sending the person to jail. And the acceptance of the punishment may be part of a process of doing penance which may result in the person finding a new and better life. In such a situation some clergymen say "Judge the sin but not the sinner", but that may not be psychologically or morally appropriate.

These are the kinds of cases that take us beyond psychology and into philosophy and religion.

Values and the Choice of Comparisons

Values present harder-than-usual questions about whom you should compare yourself to. Should you compare your moral behavior to a saint, or to an ordinary sinner? To Albert Schweitzer, or to the fellow next door? You cannot be as casual about this choice for comparison as when you choose a level of competitive tennis to set as your standard.

The value of meeting one's felt obligations to family, community, and society according to prevailing standards is often involved in depression (The prevailing standards usually are, however, far more demanding than is the norm of other people's actual conduct!) Another troublesome value is the relative importance of various aspects of life, for example, of devotion to family versus community, or devotion to success in one's profession versus family. Sometimes, even if you are very successful in many aspects of your life, your values may focus your attention on dimensions on which you do not excel, which can result in negative self-comparisons.

The development of a person's values and beliefs is complex, and differs from person to person. But it is clear that childhood experiences with parents and the rest of society influence one's values. And it seems likely that if your childhood was rigid, pressure-filled, and traumatic, you will be more rigid in your values, and less flexible in choosing a new set of values upon adult reflection, than a person who had a more relaxed childhood.

In particular, loss of love, or loss of a parent, must heavily influence one's fundamental view of the world and oneself. Loss of a parent or parental love is likely to make one feel that success, and the ensuing approval and love, are not automatic or easy to get. The loss likely makes one believe that it takes very high achievement, and the attainment of very high standards, to obtain such approval and love from the world. A person with such a view of the world is likely to conclude that her actual and potential achievements are, and will be, less than they must be to achieve love and approval; this implies hopelessness, sadness, and depression.

Of course childhood experiences persist in the adult not only as the objective experiences they were, but as the memory and interpretation of those experiences--which often are far from the objective facts.

Collapse of Values

Sometimes a person suddenly thinks, "Life has no meaning." Or to put it differently, you come to think that there is no meaning to, or value in, the activities which you had formerly thought were meaningful and valuable to yourself and the world. For one reason or another, you may come to cease accepting the values you had formerly accepted as the foundation of your life. This is Tolstoy's famous description of his "loss of meaning" and collapse of values, his subsequent depression, and his later recovery.

...something very strange began to happen to me. At first I experienced moments of perplexity and arrest of life, as though I did not know how to live or what to do; and I felt lost and became dejected.... Then these moments of perplexity began to recur oftener and oftener, and always in the same form. They were always expressed by the questions: What's it for? What does it lead to?... The questions... began to repeat them- selves frequently, and to demand replies more and more insistently; and like drops of ink always falling on one place they ran together into one black blot.

Then occurred what happens to everyone sickening with a mortal internal disease. At first trivial signs of indisposition appear to which the sick man pays no attention; then these signs reappear more and more often and merge into one uninterrupted period of suffering. The suffering increases and, before the sick man can look round, what he took for a mere indisposition has already become more important to him than anything else in the world--it is death!

That was what happened to me. I understood that it was no casual indisposition but something very important, and that if these questions constantly repeated them- selves they would have to be answered. And I tried to answer them. The questions seemed such stupid, simple, childish ones; but as soon as I touched them and tried to solve them I at once became convinced, first, that they are not childish and stupid but the most important and profound of life's questions; and secondly that, try as I would, I could not solve them. Before occupying my- self with my Samara estate, the education of my son, or the writing of a book, I had to know why I was doing it. As long as I did not know why, I could do nothing and could not live. Amid the thoughts of estate manage- ment which greatly occupied me at that time, the question would suddenly occur: 'Well, you will have 6,000 desy- atinas of land in Samara Government and 300 horses, and what then?'... And I was quite disconcerted and did not know what to think. Or when considering plans for the education of my children, I would say to myself: 'What for?' Or when considering how the peasants might become prosperous, I would suddenly say to myself: "But what does it matter to me?' Or when thinking of the fame my works would bring me, I would say to myself, 'Very well; you will be more famous than Gogol or Pushkin or Shakes- peare or Moliere, or than all the writers in the world-- and what of it?' And I could find no reply at all. The questions would not wait, they had to be answered at once, and if I did not answer them it was impossible to live. But there was no answer.

I felt that what I had been standing on had collapsed and that I had nothing left under my feet. What I had lived on no longer existed, and there was nothing left.

My life came to a standstill. I could breathe, eat, drink, and sleep, and I could not help doing these things; but there was no life, for there were no wishes the fulfillment of which I could consider reasonable. If I de- sired anything, I knew in advance that whether I satisfied my desire or not, nothing would come of it. Had a fairy come and offered to fulfill my desires I should not have known what to ask. If in moments of intoxication I felt something which, though not a wish, was a habit left by former wishes, in sober moments I knew this to be a delusion and that there was really nothing to wish for. I could not even wish to know the truth, for I guessed of what it consisted. The truth was that life is meaningless. I had as it were lived, lived, and walked, walked, till I had come to a precipice and saw clearly that there was nothing... ahead of me but destruction. It was impossible to stop, impossible to go back, and impossible to close my eyes or avoid seeing that there was nothing ahead but suffering and real death--complete annihilation.1

Some writers use the term "existential despair" to describe the same phenomenon.

A collapse in values often results from philosophical and linguistic misunderstanding of such key concepts as "meaning" and "life". These concepts seem obvious at first thought. But they are in fact often obscure and misleading, both the concepts and the words which stand for them. Making clear the confusion often reveals the implicit values.

The sense of loss of meaning is usually followed by depression, though it sometimes is followed by uncontrolled elation or by a violent oscillation between the two poles. The basic idea of this book, negative self-comparisons, explains this phenomenon: Before the event, actuality and the person's values were in balance or positive most of the time. But with the removal of one's customary values there is no longer a basis of hypothetical comparison for one's activities. Hence the result of the comparison is indeterminate but very large in one direction or the other, because there is no boundary to the comparison. The comparison is more likely to be negative than positive because the former values are likely to have been a support for, rather than a constraint of, the person's activities and life style.

Values Can Cure the Sickness Values Cause

The most interesting curative possibility for collapse of values is the discovery of new values, or the re-discovery of neglected old ones. This is what happened to Tolstoy, when he later came to believe that life itself is its own value, a belief which he also thought characterized peasant life.

Values Treatment for collapse of values will be discussed in detail in Chapter 18. We should here note, however, that though values are interwoven from childhood into the very foundations of a person's character and personality, they are nevertheless subject to change as an adult. That is, values can be accepted and rejected as a matter of personal choice, though one cannot do so lightly and casually.

Tolstoy and modern existential thinkers have thought that the "despair" of loss-of-meaning depression is the educated person's common condition. It seems to me, however, that most "educated" people's training, interests, and life circumstances do not lead them to question the values they accepted in childhood, for better or for worse, in such manner as to lead to loss of meaning.

Summary

Values and beliefs play an even more complex role in depression than do ordinary goals. Values are more fundamental than ordinary goals. We can think of values as goals that are based on the individual's deepest beliefs about human life and society, assessments of what is good and what is evil.

The collapse of a person's values can lead to depression. The most interesting curative possibility for collapse of values is the discovery of new values, or the re-discovery of neglected old ones. These possibilities will be discussed later.

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Comprehensive information on ALA (Alpha-linolenic acid) for possible treatment of ADHD, eating disorders, depression, IBD, and heart disease. Learn about the usage, dosage, side-effects of ALA.

• Overview
• Uses
• Dietary Sources
• Available Forms
• How to Take It
• Precautions
• Possible Interactions
• Supporting Research

Overview

Alpha-linolenic acid, or ALA, is an essential fatty acid, which means that it is essential to human health but cannot be manufactured by the body. For this reason, ALA must be obtained from food. ALA, as well as the fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), belongs to a group of fatty acids called omega-3 fatty acids. EPA and DHA are found primarily in fish while ALA is highly concentrated in certain plant oils such as flaxseed oil and to a lesser extent, canola, soy, perilla, and walnut oils. ALA is also found in wild plants such as purslane. Once ingested, the body converts ALA to EPA and DHA, the two types of omega-3 fatty acids more readily used by the body.

It is important to maintain an appropriate balance of omega-3 and omega-6 (another essential fatty acid) in the diet as these two substances work together to promote health. These essential fats are both examples of polyunsaturated fatty acids, or PUFAs. Omega-3 fatty acids help reduce inflammation and most omega-6 fatty acids tend to promote inflammation. An inappropriate balance of these essential fatty acids contributes to the development of disease while a proper balance helps maintain and even improve health. A healthy diet should consist of roughly two to four times more omega-6 fatty acids than omega-3 fatty acids. The typical American diet tends to contain 11 to 30 times more omega-6 fatty acids than omega-3 fatty acids and many researchers believe this imbalance is a significant factor in the rising rate of inflammatory disorders in the United States.

Omega-3 fatty acids have been shown to reduce inflammation and help prevent certain chronic diseases such as heart disease and arthritis. These essential fatty acids are highly concentrated in the brain and appear to be particularly important for cognitive and behavioral function as well as normal growth and development.

Uses of ALA

Studies suggest that ALA and other omega-3 fatty acids may be helpful in treating a variety of conditions. The evidence is strongest for heart disease and problems that contribute to heart disease, but the range of possible uses for ALA include:

Alpha-linolenic Acid for Heart Disease
One of the best ways to help prevent and treat heart disease is to eat a low-fat diet and to replace foods rich in saturated and trans-fat with those that are rich in monounsaturated and polyunsaturated fats (particularly omega-3 fatty acids). In addition to reducing risk factors for heart disease, namely high blood pressure and elevated cholesterol, evidence suggests that people who eat an ALA-rich diet are less likely to suffer a fatal heart attack.

Alpha-linolenic Acid for High Cholesterol
People who follow a Mediterranean-style diet tend to have higher HDL ("good") cholesterol levels. This diet consists of a healthy balance between omega-3 and omega-6 fatty acids. It emphasizes whole grains, root and green vegetables, daily intake of fruit, fish and poultry, olive and canola oils, and ALA (found in flaxseed oil), along with discouragement of ingestion of red meat and total avoidance of butter and cream. In addition, walnuts (which are rich in ALA) have been shown to lower cholesterol and triglycerides in people with high cholesterol.

Alpha-linolenic Acid for High Blood Pressure
Several studies suggest that diets and/or supplements rich in omega-3 fatty acids (including ALA) lower blood pressure significantly in people with hypertension. Fish high in mercury (such as tuna) should be avoided, however, because they may increase blood pressure.

Alpha-linolenic Acid for Acne
Although there are few studies to support the use of omega-3 fatty acids for skin problems, many clinicians believe that flaxseed is helpful for treating acne.

Alpha-linolenic Acid for Arthritis
Several studies suggest that omega-3 fatty acid supplements reduce tenderness in joints, decrease morning stiffness, and improve mobility. Many people who take these supplements report that they do not need as much medicine to relieve their painful symptoms.

Alpha-linolenic Acid for Asthma
Preliminary research suggests that omega-3 fatty acid supplements (particularly perilla seed oil which is rich in ALA) may decrease inflammation and improve lung function in adults with asthma.

Alpha-linolenic Acid for Eating Disorders
Studies suggest that men and women with anorexia nervosa have lower than optimal levels of polyunsaturated fatty acids (including ALA and GLA). To prevent the complications associated with essential fatty acid deficiencies, some experts recommend that treatment programs for anorexia nervosa include PUFA-rich foods or supplements.

Alpha-linolenic Acid for Breast Cancer
Women who regularly consume foods rich in omega-3 fatty acids over many years may be less likely to develop breast cancer and to die from the disease than women who do not follow such a diet. This is particularly true among women who consume fish instead of meat. Laboratory and animal studies indicate that omega-3 fatty acids can inhibit the growth of human breast cancer cells and may even prevent the spread of cancer to other parts of the body. Several experts speculate that omega-3 fatty acids, in combination with other nutrients (namely, vitamin C, vitamin E, beta-carotene, selenium, and coenzyme Q10), may prove to be of particular value for preventing and treating breast cancer.

Alpha-linolenic Acid for Burns
Essential fatty acids have been used to reduce inflammation and promote wound healing in burn victims. Animal research indicates that omega-3 fatty acids help promote a healthy balance of proteins in the body -- protein balance is important for recovery after sustaining a burn. Further research is necessary to determine if this may apply to people as well.

Alpha-linolenic Acid for Inflammatory Bowel Disease (IBD)
Some people with Crohn's disease (CD), one form of IBD, have low levels of omega-3 fatty acids in their bodies. Evidence suggests that fish oil supplements containing omega-3 fatty acids may reduce symptoms of CD and ulcerative colitis (another inflammatory bowel disease), particularly if used in addition to medication. Preliminary animal studies have found that ALA may actually be more effective than EPA and DHA found in fish oil supplements, but further studies in humans are needed to confirm these findings.

Alpha-linolenic Acid for Depression
People who do not get enough omega-3 fatty acids or do not maintain a healthy balance of omega-3 to omega-6 fatty acids in their diet may be at an increased risk for depression. The omega-3 fatty acids are important components of nerve cell membranes. They help nerve cells communicate with each other, which is an essential step in maintaining good mental health.

Alpha-linolenic Acid for Menstrual Pain
In a study of nearly 200 Danish women, those with the highest dietary intake of omega-3 fatty acids had the mildest symptoms during menstruation.

Other - Alpha-linolenic Acid for ADHD
Although further research is needed, preliminary evidence suggests that omega-3 fatty acids may also prove helpful in protecting against certain infections and in treating a variety of conditions including ulcers, migraine headaches, attention deficit/hyperactivity disorder (ADHD), preterm labor, emphysema, psoriasis, glaucoma, Lyme disease, and panic attacks.

Dietary Sources of ALA

Dietary sources of ALA include flaxseeds, flaxseed oil, canola (rapeseed) oil, soybeans and soybean oil, pumpkin seeds and pumpkin seed oil, purslane, perilla seed oil, walnuts and walnut oil.

Available Forms

There are two types of commercial ALA preparations: cooking oils (including canola oil and soybean oil) and medicinal oils (including flaxseed oil and dietary supplements containing flaxseed oil).

Some manufacturing methods can destroy the nutrient value of products that contain ALA by exposing these oil-rich products to air, heat, or light. Generally, high-quality oil is bottled in light-resistant containers, refrigerated, and marked with an expiration date. All sources of omega-3 fatty acids are best kept refrigerated to protect the quality of the oil.

Be sure to buy ALA supplements made by established companies who certify that their products are free of heavy metals such as mercury.

How to Take ALA

The recommended adequate intake of ALA in the diet is listed below:

Pediatric

• Infants that are breastfed should receive sufficient amounts of ALA if the mother has an adequate intake of this fatty acid.
• Infant formula should contain 1.5% ALA.

Adult

• 2,200 mg/day of ALA

(100 grams of raw flaxseed provides 22,800 mg of ALA; 100 grams of dried butternuts provides 8,700 mg of ALA; 100 grams of English and Persian walnuts provides 6800 mg of ALA; 100 grams of cooked soybeans provides 2,100 mg of ALA)

Precautions

Because of the potential for side effects and interactions with medications, dietary supplements should be taken only under the supervision of a knowledgeable healthcare provider.

People with either diabetes or schizophrenia may lack the ability to convert ALA to EPA and DHA, the forms more readily used in the body. Therefore, people with these conditions should obtain their omega-3 fatty acids from dietary sources rich in EPA and DHA.

Although studies have found that regular consumption of fish (which includes the omega-3 fatty acids EPA and DHA) may reduce the risk of macular degeneration, a recent study including two large groups of men and women found that diets rich in ALA may substantially increase the risk of this disease. More research is needed in this area. Until this information becomes available, it is best for people with macular degeneration to obtain omega-3 fatty acids from sources of EPA and DHA, rather than ALA.

Similar to macular degeneration, fish and fish oil may protect against prostate cancer, but ALA may be associated with increased risk of prostate cancer in men. More research in this area is needed.

Possible Interactions

If you are currently being treated with any of the following medications, you should not use ALA without first talking to your healthcare provider.

Blood-thinning Medications
Omega-3 fatty acids may increase the blood-thinning effects of warfarin, aspirin, or other blood-thinning medications. While the combination of aspirin and omega-3 fatty acids may actually be helpful under certain circumstances (such as heart disease), they should only be taken together under the guidance and supervision of your healthcare provider.

Cholesterol-lowering Medications
Following certain nutritional guidelines, including increasing the amount of omega-3 fatty acids in your diet and reducing the omega-6 to omega-3 ratio, may allow a group of cholesterol lowering medications known as "statins" (such as atorvastatin, lovastatin, and simvastatin) to work more effectively.

Cyclosporine
Taking omega-3 fatty acids during cyclosporine therapy may reduce toxic side effects (such as high blood pressure and kidney damage) associated with this medication in transplant patients.

Nonsteroidal Anti-inflammatory Drugs (NSAIDs)
In an animal study, treatment with omega-3 fatty acids reduced the risk of ulcers from nonsteroidal anti-inflammatory drugs (NSAIDs). More research is needed to evaluate whether omega-3 fatty acids would have the same effects in people.

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Self-Therapy For People Who ENJOY Learning About Themselves

If we work and live around other people, we get angry about twenty times every day.

And yet many people would swear they seldom get angry at all. We tend to be so afraid of our anger that, as a culture, we pretend it isn't there.

OBSTACLES
Our anger is there to protect us and to help us overcome obstacles to what we want. But if we are too afraid to use it, we become our own obstacle.

ANGER AND GUILT
The biggest problem with anger is guilt.

Since we have been taught that anger is bad, we pretend that we aren't angry and claim to be "hurt" instead.

This waters down the intensity of our anger, greatly complicates our attempts to get what we want, and ultimately sets us up as "victims" or "martyrs."

FEAR OF RAGE
Intense anger is called rage. It is so intense, that it begs for a physical release.

It is very common to think about violence when we feel rage, but thought is not action and violence is never necessary (except to protect our lives, of course).

When You Have Violent Images, Remember:

1. The images are only a fantasy, and it is normal to have them at times like this.
2. You do not have to act out what you imagine, so there's no reason for fear.
3. Violent fantasies are just a measure of how angry you are. It's good for you to know you are so angry.
4. The fantasies are only telling you that you want to use your body to express all this anger. Go ahead! Hit a pillow, smash some old glassware, do anything that helps you to release all that anger - as long as it doesn't physically hurt you or anyone else.
5. When you are finished, you will feel relief.
6. After the relief, decide what you are going to do about the situation that got you so angry in the first place.

PROBLEMS WITH UNNATURAL ANGER

Unnatural anger occurs when we think we are angry but we are actually feeling some other feeling (sadness, scare, joy, excitement or guilt).

MOST COMMON PROBLEM

The most common problem is using unnatural anger to cover up both sadness and fear.

We all know some "grouches" or "chronic complainers." From our perspective on the outside, these people seem to be constantly angry. They may yell, or say mean things, or simply complain all the time.

When you meet these people, know that they are not particularly angry! (If they were really angry there would be a natural duration to their anger and they would have been finished with it a long time ago.)

These people usually have suffered intense sadness and fear for years. They gave up on life many years ago, possibly after feeling abandoned by someone.

They are sad because they feel they've "lost everything." They are fearful because they think they have nobody to help them stay safe.

What they need is a close relationship with people they trust. But, sadly, they will fight this off very, very well.

OTHER PROBLEMS

When I hear this, I usually ask: "Well, would you?"
And they say: "No, of course not!".
And I say: "Then all you need to do is believe yourself...."
(Of course if you really are afraid you might kill or hurt someone - yourself or anyone else - stop reading this right now, get on the phone, and call a good therapist!)

"Who Do You Think You Are, Young Man!" When children get angry at adults, the adults frequently respond with demeaning comments designed to "put the child in his place." As adults, we need to overcome this negative childhood conditioning and reclaim our power.

Anger = Energy = Power
When we are angry we are feeling raw energy that is ready for use. This is our power.

The only real decision we have to make is: "How will I use all this power?"

Your anger is like a laser beam. Aim it precisely where it will do you the most good.

A REMINDER

We all confuse our feelings sometimes.

If you thought you had a problem with anger but these words don't fit, your problem may be related to one of the other feelings.

Also, be sure you've read ---> ANGER - HOW IT WORKS NATURALLY

Enjoy Your Changes!

Everything here is designed to help you do just that!

next: Problems With Sadness

There's so much misinformation about ADHD, our expert Dr. Billy Levin provides a clear, concise description of what ADHD is and isn't.

I have decided to write this very short article in response to the many parents and patients experiencing major problems with  ADHD and not being aware why this is happening or what can be done to achieve success. I sincerely hope this very brief description will foster and encourage more attempts at obtaining detailed and accurate information and insight and demand better management for them or their children.

ADHD (Attentional Deficit Hyperactivity Disorder)  is a very real and devastating genetically inherited neurological condition. For most, the condition is severe enough to warrant medical treatment and possibly further intervention. It presents as either a right brain dominance behaviour problem (Hyperactivity) or a left-brain immaturity-learning problem (Attentional Deficit Disorder), or various degrees of both. As both hemispheres have so many varied functions the symptoms are very wide and varied. It is not caused by diet factors, poor parenting or family strife, but these factors may aggravate the condition.

It presents at any age but the behaviour problems are more readily recognised as they are so disruptive. ADD is often missed and neglected. However no person is too young or too old to be treated, if treatment is necessary.

The condition has, not only classical symptoms but also, often, external features to testify to the inherited nature of this condition. There is a clear-cut examination procedure that does not require any Psychological investigation nor an electro-encephalo-gram .The diagnosis can be finalised within two hours in a doctor's consulting room. However spesific-rating scales completed by parents and teacher are essential, as is the evaluation of the developmental and family history and previous school reports. The 12 question, modified Conner's rating that I use can show behaviour, learning and emotional problems as well as their severity with 95% accuracy. Used in a series it can instantly reveal the effectiveness or lack there of, of medical treatment and other interventions. There is no need for an Occupational therapy assessment. Because it is a medical condition it is the doctor's responsibility to not only diagnose, but also fully inform patient, parents and school about the diagnosis and treatment\and request cooperation from all, including the patient.

There is also an absolute need to monitor medication using rating scales on a regular basis, preferably monthly. To do this effectively the school and parents must have complete insight into how the rating scales function. The purpose of monitoring is to evaluate the need to adjust medical treatment to an optimal level. Anything less will not allow the patient to be taught or to behave in an acceptable manner. Sympathetic recognition of this situation will prevent the patient from being punished for an inherited condition inadequately treated. Effective medical treatment is possible within ten days, but success takes longer.

The medical treatment is stimulant medication used seven days a week. There are no long-term serious side effects to this treatment. The minor transient side effects are easily managed by a competent doctor and enlightened patients or parents of the patient. There is almost never a need to stop medical treatment because of the minor transient side effects. The timing of medication is vital as rebound symptoms flare up if treatment is not continuous. Very young children do sometimes not respond well to stimulant medication. Thus there is sometimes a need for other medication as well.

Some patient, tend to outgrow  ADHD due to maturity taking place, if it is mild enough. These individuals usually have a good I.Q. tinuous treatment like in Gout, Hypertension, Diabetes and many other medical conditions. Thesand the circumstances for motivation and acceptance are favourable and treatment is continuous and started early enough. Delayed diagnosis, ineffective treatment, poor circumstances and petty parenting may lead to complications like Oppositional Defiant Disorder or Conduct Disorder (delinquency) in the teenage years. Some patients will unfortunately require permanent and cone conditions, as in ADHD, the treatment is aimed at effective control as there is no cure.

In teenagers and adults, non-treatment or non recognition or ineffective treatment may lead to school drop-out, delinquency, drugging, driving accidents, job drifting, drinking problems, depression, divorce and in extreme cases death. Death from drugging over dose, driving under influence of alcohol and accidents, depression and suicide. The condition must be seen as far too serious to be taken lightly or neglected. It affects not only the patient but the whole family and even society. Doctors must have the knowledge insight and understanding to fully recognise, advise and treat effectively. If ten percent of our population have this condition, at least half (5%) need treatment. Nowhere are more than two percent receiving treatment and less than one percent are receiving effective treatment. Drug holidays are not advisable.

This clearly suggests a large percentage of our population are not only, not receiving treatment, they do not even know why they have problems. Lack of knowledge and insight particularly in schools cannot help and misinformation is a major factor fostered by media sensationalism. Neglected and abused patients have a legal, moral and ethical right to recognition and effective and scientific treatment. The cost to society caused by neglect of ADHD runs into millions annually! A knowledgeable and sympathetic team is the secret to attainable success for 95% of cases. Is it not long overdue for patients, parents, schools, doctors and society to unite in a common Cause? After all our children are our future!

About the author: Dr. Levin is a paediatrician with nearly 30 years of experience.   He is a specialist in treating ADHD and has published many papers on the subject.   Dr. Levin is our "ask-the-expert."