Dear Dr. Bob,
I have been prescribed Klonopin by my doctor for anxiety. I'm concerned about becoming addicted or the long term side effects. Can you help out?
Susan, Fremont
Dear Susan,
Discussions about medication should be really addressed with your doctor or psychiatrist. Yes, Klonopin, as are other benzodiazepines, can become addictive. But not for everyone. The key is always medication management. Increase in use may indicate a tolerance and a need for increased frequency or dosage. Please discuss both the potential for addiction and side effects with your medical practitioner. Ask about non-addictive alternatives as well as a referral to a cognitive behavioral therapist to treat anxiety.
Dr. Bob
Sunday, October 31, 2010
Saturday, October 30, 2010
My Dad
Dear Dr. Bob,
There is something wrong with my dad. He hardly ever calls me, talks only about himself when he does, and gets his feeling hurt if I plan things and don't invite him. What's his problem?
Janet, Pleasanton
Dear Janet,
There is plenty of information available on the web about personality traits and disorders. I suspect your dad has been this way awhile, if not a long while, and he seems to be ok with who he is. If you talk to him about the relationship, he may not be willing or able to change. In his mind, I suspect he doesn't think he has a problem. It appears you have a problem because you want to have a different type of father. It sounds like you don't get what you need from him and that is very hurtful.
Accepting our parents for who they are, and who they are not, is one of life's most difficult challenges. Coping with life on life's terms is a life long growth step. However if the relationship is toxic or abusive (rather than simply annoying), it's best to protect yourself with some distance between the two of you. At that point the acceptance is not of his behavior, which is unacceptable, but that he is a troubled man whose problems you can't fix. If you can tolerate your dad, some professional help may assist you in understanding why this relationship is so painful and what you can do to maintain it. Relationships sometimes change over time as both parties get older and wiser!
Dr. B
There is something wrong with my dad. He hardly ever calls me, talks only about himself when he does, and gets his feeling hurt if I plan things and don't invite him. What's his problem?
Janet, Pleasanton
Dear Janet,
There is plenty of information available on the web about personality traits and disorders. I suspect your dad has been this way awhile, if not a long while, and he seems to be ok with who he is. If you talk to him about the relationship, he may not be willing or able to change. In his mind, I suspect he doesn't think he has a problem. It appears you have a problem because you want to have a different type of father. It sounds like you don't get what you need from him and that is very hurtful.
Accepting our parents for who they are, and who they are not, is one of life's most difficult challenges. Coping with life on life's terms is a life long growth step. However if the relationship is toxic or abusive (rather than simply annoying), it's best to protect yourself with some distance between the two of you. At that point the acceptance is not of his behavior, which is unacceptable, but that he is a troubled man whose problems you can't fix. If you can tolerate your dad, some professional help may assist you in understanding why this relationship is so painful and what you can do to maintain it. Relationships sometimes change over time as both parties get older and wiser!
Dr. B
Genetic Predisposition
Dear Dr. Bob,
Both of my parents are Recovering Alcoholics and they keep preaching about how I'll become one too if I keep drinking. But I'm only 17. Aren't I too young?
Jamie, Half Moon Bay
Dear Jamie,
The project to map all human genes isn't finished yet. The theory about an alcoholism or addiction gene hasn't been proven either. All of the information is corollary. But the studies of addiction in families is voluminous, especially the Scandinavian studies of twins separated at birth from alcoholic families, raised in abstinent families, still become alcoholic by adulthood. This is not to say role modeling isn't a factor in human development, but in these cases, the genetics are hard to ignore. With a genetic predisposition, it seems to take less exposure to mood altering substances to develop a dependency. It's like when you have genetically light complected skin. It takes less exposure to sunlight to become sunburnt. The only 100% way to prevent sunburn is not to be exposed to sunlight.
There is also considerable research available about teenage alcoholism. Since some people start drinking as pre-teens, by the time they are teenagers, alcohol has become part of their physiological development. We know enough about how alcohol affect brain development to know that the earlier in life when someone starts drinking, the more significant the effects will be. With the way life can be challenging and stressful, it's hard enough to cope with problems with a normal brain, isn't it?
Dr. B
Both of my parents are Recovering Alcoholics and they keep preaching about how I'll become one too if I keep drinking. But I'm only 17. Aren't I too young?
Jamie, Half Moon Bay
Dear Jamie,
The project to map all human genes isn't finished yet. The theory about an alcoholism or addiction gene hasn't been proven either. All of the information is corollary. But the studies of addiction in families is voluminous, especially the Scandinavian studies of twins separated at birth from alcoholic families, raised in abstinent families, still become alcoholic by adulthood. This is not to say role modeling isn't a factor in human development, but in these cases, the genetics are hard to ignore. With a genetic predisposition, it seems to take less exposure to mood altering substances to develop a dependency. It's like when you have genetically light complected skin. It takes less exposure to sunlight to become sunburnt. The only 100% way to prevent sunburn is not to be exposed to sunlight.
There is also considerable research available about teenage alcoholism. Since some people start drinking as pre-teens, by the time they are teenagers, alcohol has become part of their physiological development. We know enough about how alcohol affect brain development to know that the earlier in life when someone starts drinking, the more significant the effects will be. With the way life can be challenging and stressful, it's hard enough to cope with problems with a normal brain, isn't it?
Dr. B
Grieving and Depression
Dear Dr. Bob,
My grandfather died a few months ago and he was more of a father to me than my own absentee father. I still feel sad, but everyone tells me I'm depressed and need help. What kind of help?
Samantha, Hayward
Dear Samantha,
You have actually asked several questions at once. Almost everyone in the psychological field uses the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) to classify emotional problems. The fine lines between the diagnoses of Bereavement, Adjustment Disorder with Depression and Major Depressive Disorder (and Minor Depressive Disorder not officially used yet) are often times obscure. Although the DSM-IV-TR addresses the issues of time spent grieving and the nature of depressive symptoms as part of the differential diagnoses, it is also a well accepted fact that "normal" grieving is different for different people and different cultural groups. To make a generalization for the sake of brevity, the longer the grief (two months or more) and the severity of the experience (guilt, thoughts of death, preoccupation with worthlessness, etc) the more it becomes Major Depressive Disorder.
Feeling sad is considered a typical grief reaction. You do not need to feel depressed to get help through a support group or counseling. Self medicating with drugs or alcohol is a common form of coping with death, but not usually helpful. Ultimately, one still has to grieve and drinking and drugging can lead to other problems in addition to grief or depression. Sort of like jumping out of the pan into the fire! Reach out for some help, you won't regret it.
Dr. B
My grandfather died a few months ago and he was more of a father to me than my own absentee father. I still feel sad, but everyone tells me I'm depressed and need help. What kind of help?
Samantha, Hayward
Dear Samantha,
You have actually asked several questions at once. Almost everyone in the psychological field uses the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) to classify emotional problems. The fine lines between the diagnoses of Bereavement, Adjustment Disorder with Depression and Major Depressive Disorder (and Minor Depressive Disorder not officially used yet) are often times obscure. Although the DSM-IV-TR addresses the issues of time spent grieving and the nature of depressive symptoms as part of the differential diagnoses, it is also a well accepted fact that "normal" grieving is different for different people and different cultural groups. To make a generalization for the sake of brevity, the longer the grief (two months or more) and the severity of the experience (guilt, thoughts of death, preoccupation with worthlessness, etc) the more it becomes Major Depressive Disorder.
Feeling sad is considered a typical grief reaction. You do not need to feel depressed to get help through a support group or counseling. Self medicating with drugs or alcohol is a common form of coping with death, but not usually helpful. Ultimately, one still has to grieve and drinking and drugging can lead to other problems in addition to grief or depression. Sort of like jumping out of the pan into the fire! Reach out for some help, you won't regret it.
Dr. B
The Cost of Counseling
Dear Dr. Bob,
My wife and I attend marriage counseling at the recommendation of my sponsor. I think its pretty expensive! How long should I go?
Dan, Pacifica
Dear Dan,
How much do you think you spent on alcohol and drugs when you were using? How much do you think a divorce will cost you? Go to counseling until you, your wife and the counselor agree it's no longer needed. Learning about yourself and building a strong relationship with your wife is priceless!
Dr. B
My wife and I attend marriage counseling at the recommendation of my sponsor. I think its pretty expensive! How long should I go?
Dan, Pacifica
Dear Dan,
How much do you think you spent on alcohol and drugs when you were using? How much do you think a divorce will cost you? Go to counseling until you, your wife and the counselor agree it's no longer needed. Learning about yourself and building a strong relationship with your wife is priceless!
Dr. B
Monday, October 25, 2010
Proposition 19
Dear Dr. Bob,
Do you have any opinions about Prop 19 in California that allows for legalized marijuana?
Cynthia, Walnut Creek
Dear Cynthia,
As you know California Proposition 19 calls for the regulation, control and taxation of cannabis. And as you also know, this is an extremely controversial issue. It seems to me to be the latest chapter in the struggle between groups who want to control whether government or individuals know what's best about their own welfare. And it may be an attempt to change hypocritical Prohibition Era ideas toward marijuana, which is illegal, while alcohol is far more lethal. There is some interesting history about how marijuana became illegal, a successful effort by the tobacco farmers in 1933. But that's for another time... Many countries have far more lenient or far more strict laws about alcohol or drug use than the United States, with varying results of the impact on society and individuals.
The issue is not the substance, its the substance user. As the saying goes, "guns don't kill people, people kill people". Drugs and alcohol are not the problem. Otherwise everyone who drinks or uses would become dependent, which is not the case. In the drug and alcohol treatment field, we think of addiction using a bio-psycho-social model. We tend to have a very stressful competitive society which accepts self medication of all kinds, add that to an individual that may have some developmental psychological wounds and or a genetic predisposition, and the recipe for addiction is set. But the recipe is not set for everyone! No two people have the same genes, the same development and the same experience. Even identical twins raised in the same family have different interpretations of their existence.
Having said all of that, most dependency can be simplified by this question: "Does the individual control their use, or does their use control them?" Whatever the substance, if it controls a person's life, whether it's legal or illegal, they will have plenty of problems because of it. Moderation seems to be the way to go with any psychoactive substance, food, behavior, etc., which is not an easy option for many.
Dr.B
Do you have any opinions about Prop 19 in California that allows for legalized marijuana?
Cynthia, Walnut Creek
Dear Cynthia,
As you know California Proposition 19 calls for the regulation, control and taxation of cannabis. And as you also know, this is an extremely controversial issue. It seems to me to be the latest chapter in the struggle between groups who want to control whether government or individuals know what's best about their own welfare. And it may be an attempt to change hypocritical Prohibition Era ideas toward marijuana, which is illegal, while alcohol is far more lethal. There is some interesting history about how marijuana became illegal, a successful effort by the tobacco farmers in 1933. But that's for another time... Many countries have far more lenient or far more strict laws about alcohol or drug use than the United States, with varying results of the impact on society and individuals.
The issue is not the substance, its the substance user. As the saying goes, "guns don't kill people, people kill people". Drugs and alcohol are not the problem. Otherwise everyone who drinks or uses would become dependent, which is not the case. In the drug and alcohol treatment field, we think of addiction using a bio-psycho-social model. We tend to have a very stressful competitive society which accepts self medication of all kinds, add that to an individual that may have some developmental psychological wounds and or a genetic predisposition, and the recipe for addiction is set. But the recipe is not set for everyone! No two people have the same genes, the same development and the same experience. Even identical twins raised in the same family have different interpretations of their existence.
Having said all of that, most dependency can be simplified by this question: "Does the individual control their use, or does their use control them?" Whatever the substance, if it controls a person's life, whether it's legal or illegal, they will have plenty of problems because of it. Moderation seems to be the way to go with any psychoactive substance, food, behavior, etc., which is not an easy option for many.
Dr.B
Sunday, October 24, 2010
Dual Diagnosis
Dear Dr. Bob,
Dear Tom,
Dual diagnosis is a term used both in mental health and chemical dependency fields to describe a client's condition when both a psychiatric disorder and a drug or alcohol problem occurs. Often times the signs or symptoms can mask or mimic each other. For instance, a hangover or coming down from meth could look like depression, or depression can be mistaken for chronic marijuana use. The "high" of stimulants looks similar to a manic phase of Bi-Polar and vice versa. And hallucinations, usually auditory or visual are the hallmarks of psychosis and hallucinogenic drugs like LSD.
It used to be drug and/or alcohol problems were seen as symptomatic of an underlying psychiatric disorder, the psychiatric disorder would be treated first, hoping the drug or alcohol symptoms would go away as the patient got better. Treating the underlying issues while the client is still actively using drugs and alcohol has proven ineffective. Now chemical dependency is seen as both: a primary problem and symptomatic of underlying issues. Therefore, the easier and more effective treatment approach is to remove the drugs and alcohol, in essence, get sober and see what other thought, mood, or personality issues remain.
Should there be thought, mood, or personality problems that remain a barrier to long term recovery and good mental health, working a good program of meetings and steps with your sponsor, and seeking professional help, would be in order.
Dr. B.
I just came out of a drug and alcohol rehab program and my counselor says I might have depression or be "dual diagnosis". What is that?
Tom, SF
Dear Tom,
Dual diagnosis is a term used both in mental health and chemical dependency fields to describe a client's condition when both a psychiatric disorder and a drug or alcohol problem occurs. Often times the signs or symptoms can mask or mimic each other. For instance, a hangover or coming down from meth could look like depression, or depression can be mistaken for chronic marijuana use. The "high" of stimulants looks similar to a manic phase of Bi-Polar and vice versa. And hallucinations, usually auditory or visual are the hallmarks of psychosis and hallucinogenic drugs like LSD.
It used to be drug and/or alcohol problems were seen as symptomatic of an underlying psychiatric disorder, the psychiatric disorder would be treated first, hoping the drug or alcohol symptoms would go away as the patient got better. Treating the underlying issues while the client is still actively using drugs and alcohol has proven ineffective. Now chemical dependency is seen as both: a primary problem and symptomatic of underlying issues. Therefore, the easier and more effective treatment approach is to remove the drugs and alcohol, in essence, get sober and see what other thought, mood, or personality issues remain.
Should there be thought, mood, or personality problems that remain a barrier to long term recovery and good mental health, working a good program of meetings and steps with your sponsor, and seeking professional help, would be in order.
Dr. B.
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