As a psychologist working in the field of addiction, I am often asked about basic alcohol assessment tools.  People want a simple way to identify possible alcohol and substance abuse problems.  There are many screening tools available.  The CAGE is one of these tools.  Healthline.com says it is a questionnaire that professionals use to check for possible signs of alcohol dependency.  The questionnaire has four unobtrusive questions asking someone about their alcohol use.

 

 

CAGE is an acronym that make the four questions easy to remember.

Cut:               Have your ever felt you should cut down on your drinking?

Annoyed:     Have people annoyed you by criticizing your drinking?

Guilty:          Have  you ever felt guilty about your drinking?

Eye-opener:  Have you ever had a drink first thing in the morning (eye-opener) to steady your nerves or get rid of a hangover?

The person gives a yes or no answer to each question.  Each yes answer increases the possibility that the person may have alcohol dependency.  As a rule, 2 or 3 “yes” answers indicate possible alcohol problems.  Physicians sometimes attach more significance to question four, because it is a sign that someone might have withdrawal symptoms.

There is a variation of the CAGE questionnaire called the CAGE-AID.  This questionnaire adds AID for – adapted to include drugs.  It uses the same questions as the CAGE.  However, it adds drug use along with drinking.

The CAGE asks direct questions.  It helps the person consider their alcohol use without judgement.  It is not a foolproof test.  It is a simple screening tool that can be used quickly to identify potential problems.  It was designed to be used by physicians as a way get helpful alcohol consumption information.  The questions are worth considering for anyone who thinks they might be developing or have a drinking problem.   I hope you find this information helpful when considering alcohol consumption for yourself or people you care about.

Sincerely,

Steven J. Chen, Ph.D.

 

 

Helpful Marital Tips

 

 

 

 

 

 

 

 

 

 

 

 

Every marriage has ups and downs.  In the Focus on the Family article, 10 Secrets to a Successful Marriage, Mitch Temple gives helpful marital tips.  Couples who consider these tips can learn to navigate challenges in a successful manner.  Here is a summary of the 10 principles or tips.

1.  Focus on bringing happiness into the marriage.  People want to be happy, but happiness isn’t the most important thing.  Successful couples learn to intentionally do things to bring happiness into the marriage when life has challenges.
2. There is value in simply showing up for each other.  When things are tough and people don’t know what to do, they need to simply be there for each other.  Over time, people will have the opportunity to work together, reduce stress, and work things out.
3. If you do things the same way, you will get the same result.  Wise people learn that you have to do things differently to get a different outcome.  Small changes in attitude, actions, or approach can make big differences.
4. Your attitude matters.  Changing behavior is important, but so is changing your attitude.  A negative attitude often creates bad feelings and actions.
5. Change your mind, change your marriage.  What people believe about their spouse affects how they treat each other.
6. Successful couples don’t believe the myth that grass is greener somewhere else.  They have learned to put energy into making themselves and their relationship better.  They have learned to “water their own grass.”
7. You can change your marriage by changing yourself.  Experienced couples have learned that it is very difficult to change your partner.  The only person we can really change is ourselves.
8. Love is a verb, not just a feeling.  Feelings go up and down, but real love is based on commitment.
9. Marriage is often about fighting the battle in your own mind.  Successful couples have learned to resist holding grudges and bringing up the past.  They remember that they married an imperfect person and that they are imperfect as well.
10. A crisis does not mean the marriage is over.  Crises can be very stressful and upsetting.  However, couples can make it through and be stronger in the long run.

Holiday Stress

Stress is a very common problem during the holidays.  Unfortunately, alleviating stress is not easy to do.  During this time of year, there are many demands on our time such as shopping, cooking, baking, cleaning, work, and entertaining.  The Covid-19 pandemic may also be adding stress due to worry about you and your families’ health.  Your holiday plans may also be different due to the pandemic.

Health Line provides a list of tips that can decrease stress over the holidays.  Here is a summary of their recommendations.

1. Plan Ahead

Finding time for all the holiday activities can be difficult.  Creating a plan of action can help.  Writing down the things you need to accomplish and then prioritizing them can be helpful.  Also, you are less likely to forget things if you have a list.

2. Put Yourself First

During the holidays, people focus on giving.  It is easy to forget to look out for yourself.  Taking care of yourself will improve your mood and help you take care of others.

3. Keep Your Finances in Check

Be realistic about what you can afford to spend over the holidays.  Create a budget and stick to it.  If you are not in the position to spend money, then bake a treat, share talents, or spend time with family and friends.  The sentiment behind the gift is more important than the monetary value.

4. Honor Love Ones

The holidays can be difficult if you have lost someone or cannot be with friends and family.  If you have lost someone, spending time reflecting on happy memories can brighten your mood.  You are unable to be near loved ones, you might give them a call, plan a zoom party, or send them a note.

5. Indulge in Moderation

It is fun to have treats or try new foods over the holidays, but don’t forget to eat healthy and take care of yourself.  Remember to pace yourself, overeating can leave you feeling sick and lethargic.

6. Do Not Be Afraid to Say No

It is okay to say “no”.

Only say “yes” to events and plans that will bring you happiness and joy.

 

Hopefully, this list should help you reduce your stress and worry over the holidays!

 

Why Keep A Gratitude Journal?

Why keep a gratitude journal?  In 2020, many people have suffered emotional, physical, and financial hardships.  When experiencing challenges, it is easy to focus on the negative and lose sight of positive things.   Keeping a gratitude journal is a good way to train our minds to focus on the positive.  In 2003 a study conducted by Emmons and McCullough, found that keeping a daily gratitude journal lead to better sleep, reduction of pain, a greater sense of well-being and more resilience dealing with change.  When we focus on good things, we are healthier and happier.

Experts recommend different ways to keep a gratitude journal.  One approach is to take 5 minutes each day and write down a few things you are thankful for.  A second option is to set aside 15 minutes once a week for two weeks to establish a pattern.  A third approach is to write journal entries 3 times per week to make a positive change.  Whatever approach you take, the key seems to be consistency.  Training your mind to consistently focus on the positive.

The article by, Greater Good in Action, provides people with ideas on how to keep a gratitude journal.  I have summarized their suggestions in the following list.

1. Write down 3-5 things for which you feel grateful.
2. Be as specific as possible.
3. If you describe people in specific detail it has more impact than making a superficial list.
4. Focus on people rather than things. We are more impacted by relationships.
5. Be aware of subtraction, not just addition. Don’t just make a list of good things.  Consider what life would be like without specific people or be grateful for negative outcomes you avoided.
6. Enjoy surprises. Record events that are unexpected.
7. Do not just write about the same things, consider different aspects of a person or situation.
8. Honor your commitment to write regularly.

Most importantly, you don’t have to keep a perfect gratitude journal.  Just get started!

 

More Healthy Sleep Information

Today, there is much more healthy sleep information available.  According to researchers, how sleepy you are depends on how well you have been sleeping and how much sleep you are getting.  We each have a “biological clock” – a tiny bundle of cells in your brain that responds to light signals through your eyes and promotes wakefulness.  Due to the timing of the biological clock and other bodily processes, you naturally feel drowsy between midnight and 7 a.m. and again in the afternoon between 1 p.m. and 4 p.m.

Night shift workers often find themselves drowsy at work.  They also have trouble falling asleep or staying asleep during the day, when their schedules require them to sleep.  Being sleepy puts them at risk for injuries on the road and at work.  Night shift workers are also more likely to have conditions such as heart disease, digestive disorder, and infertility, as well as emotional problems.  All of these problems may be related, at least in part, to their chronic lack of sleep.

Adapting to new sleep and wake times can also be hard for travelers crossing time zones, resulting in what’s known as jet lag.  Jet lag can lead to daytime sleepiness, trouble falling asleep or staying asleep at night, poor concentration, and irritability.

The good news is that by using appropriately timed cues, most people can change their biological clock, but only by 1-2 hours per day at best.  Therefore, it can take several days to adjust to a new time zone (or different work schedule).  If you’ll be moving across time zones, you might want to begin adapting to the new time zone a few days before leaving.  Or, if you are traveling for just a few days, you might want to stick with your original sleep schedule and not try to adjust to the new time zone.

Tips to Help With Sleep

Just like eating well and being physically active are important for good health, getting a good night’s sleep is vital to your well-being.  Here are 13 tips to help with sleep:

Stick to a sleep schedule.  Go to bed and wake up at the same time each day – even on the weekends.

Exercise is great, but not too late in the day.  Avoid exercising closer than 5 or 6 hours  before bedtime.

Avoid caffeine and nicotine.  The stimulating effects of caffeine in coffee, colas, teas, and chocolate can take as long as 8 hours to wear off fully.  Nicotine is also a stimulant.

Avoid alcoholic drinks before bed.  A “nightcap” might help you get to sleep, but alcohol keeps you in the lighter stages of sleep.  You also tend to wake up in the middle of the night when the sedating effects have worn off.

Avoid large meals and beverages late at night.  A large meal and cause indigestion and interferes with sleep.  Drinking too many fluids at night can cause you to awaken frequently to urinate.

Avoid medicines that delay or disrupt your sleep, if possible.  Some commonly prescribed heart, blood pressure, or asthma medications, as well as some over-the-counter and herbal remedies for coughs, colds, or allergies, can disrupt sleep patterns.

Don’t take naps after 3 p.m.  Naps can boost your brain power, but late afternoon naps can make it harder to fall asleep at night.  Also, keep naps to under one hour.

Relax before bedtime.  Take time to unwind.  A relaxing activity, such as reading or listening to music, should be part of your bedtime ritual.

Take a hot bath before bed.  The drop in body temperature after the bath may help you feel sleepy, and the bath can help relax you.

Have a good sleep environment.  Get rid of anything that might distract you from sleep, such as noises, bright lights, an uncomfortable bed, or a TV or computer in the bedroom.  Also keeping the temperature in your bedroom on the cool side can help you sleep better.

Have the right sunlight exposure.  Daylight is key to regulating daily sleep patterns.  Try to get outside in normal sunlight for at least 30 minutes each day.

Don’t lie in bed awake.  If you find yourself still awake after staying in bed for more than 20 minutes, get up and do some relaxing activity until you feel sleepy.  The anxiety of not being able to sleep can make it harder to fall asleep.

See a doctor if you continue to have trouble sleeping.  If you consistently find yourself feeling tired or not well rested during the day despite spending enough time in bed at night, you may have a sleep disorder.  Your family doctor or a sleep specialist should be able to help you.  Another good source of information is the National Sleep Foundation Website which can help you find resources in your area.

The information in this article is adapted and updated under license from Claire Communications.

                                                      Healthy Sleep

We all need to develop healthy sleep patterns.  When you are overwhelmed with work, school, family, or household responsibilities, do you cut back on your sleep?  Many people, believe that sleep is merely a “down time” when the brain shuts off and the body rests.  However, people need to re-think this view of sleep.

What Is Sleep?

In the past, sleep was considered just a block of time when you are not awake.  Thanks to sleep studies done over the past several decades, it is now known that sleep has distinctive stages that cycle throughout the night.  Your brain stays active throughout sleep, but different things happen during each stage.  For instance, certain stages of sleep are needed for us to feel well rested and energetic the next day, and other stages help us learn or make memories.

There are a number of vital tasks that are carried out during sleep which help maintain good health and enable people to function at their best.  Not getting enough sleep can be dangerous.  For example, you are more likely to be in a car crash if you drive when you are drowsy.

How Much Sleep Is Enough?

Sleep needs vary and they change throughout the life cycle.  Infants sleep between 16-18 hours a day.  Children in preschool sleep between 9-12 hours a day.  According to the Centers for Disease Control and Prevention, children ages 6-12 require 9- 12 hours of sleep and teens ages 13-18 need 8-10 hours of sleep per 24 hour period.  Most adults need approximately 7 – 8 hours of sleep.

Some people believe that adults need less sleep as they get older.  But there is no evidence to show that older people can get by with less sleep than younger people.

As people age; however, they often get less sleep or they tend to spend less time in the deep, restful stages of sleep.  Older people are also more easily awakened.

Why Sleep Is Good For You – And Skimping On It Isn’t

Does it really matter if you get enough sleep?  Absolutely!  Not only does the quantity of your sleep matter, but the quality of your sleep is important as well.  People whose sleep is interrupted a lot or is cut short might not get enough of certain stages of sleep.  In  other words, how well rested you are and how well your function the next day depend on your total sleep time and how much of the various stages of sleep you get each night.

Performance

We need sleep to think clearly, react quickly, and create memories.  In the article, Sleep Learning, and Memory, Dr. Robert Stickgold talks about how sleeps impacts memory before and after learning a new skill.  In fact, the pathways in the brain that help us learn and remember are very active when we sleep.  Studies show that people who are taught mentally challenging tasks do better after a good night’s sleep.  Other research suggests that sleep is needed for creative problem solving.

Skimping On Sleep Has A Price

Cutting back on even 1 hour can make it tough to focus the next day and can slow your response time.  Studies also find that when you lack sleep, your are more likely to make bad decisions and take more risks.  This can result in lower performance on the job or in school.

Mood

Sleep also affect mood.  Insufficient sleep can make you irritable and is linked to poor behavior and trouble with relationships, especially among children and teens.  People who chronically lack sleep are also more likely to become depressed.

Health

Sleep is also important for good health.  Studies show that not getting enough sleep or getting poor quality sleep on a regular basis increases the risk of having high blood pressure, heart disease, and other medical conditions.

In addition, during sleep, your body produces valuable hormones.  Deep sleep triggers more release of growth hormone, which fuels growth in children, and helps build muscle mass and repair cells and tissues in children and adults.  Another type of hormone that increases during sleep works to fight various infections.

This might explain why a good night’s sleep helps keep you from getting sick – and helps you recover when you do get sick.  Hormones released during sleep also affect how the body uses energy.  Studies find that the less people sleep, the more likely they are to be overweight or obese, to develop diabetes, and to prefer eating food that are high in calories and carbohydrates.

As you can see, there are numerous performance, mood, and health reasons to focus on sleep.  We all need to develop healthy sleeping patterns.

The information in this article is adapted and updated under license from Claire Communications.

 

 

Struggling With Relapse

Due to current stressors, many people are struggling with relapse.  The National Drug Institute reports that 40 to 60 percent of people who go through addiction treatment relapse at least once and some relapse multiple times.  The website TherapistAid.com provides an excellent free worksheet with Tips for Avoiding Relapse.  The following is a condensed version of the TherapistAid.com worksheet:

Tips for Avoiding Relapse

The most important moment before relapse isn’t the final decision to use a substance or act out.  It happens when you decide to expose yourself to triggers.  Examples of triggers are going to a party or walking through the liquor section at the store.  Before encountering triggers, you still have most of the control.  Not your craving.

If you are feeling the urge to use, try to wait it out.  If you distract yourself for even 30 minutes, it’s likely your craving will lessen in intensity.  It might not totally disappear, but it will become easier to resist.

Focus on replacing your past use with new positive activities.  If you used to go home after work and drink, you’ll need to make a new plan.  Going home and staring at a wall will eventually lead to staring at a wall with a drink in your hand.

Do not try to do this alone.  Sharing your goals for sobriety with a friend makes all the difference.  They can hold you accountable when you are making questionable decisions.  They can also offer support when you are struggling.

Remind yourself that cravings will pass.  Have you ever had that experience when you are sick where you can not remember what it feels like to not be sick?  The same thing happens with cravings.  Give it time, and believe it or not, the feelings will go away.

You will have to make sacrifices beyond giving up the drug.  If you previously used drug specific activities (watching a game on TV or going to concerts), you may need to make changes.  This might mean not watching the game or making new friends who are sober.  This can be really hard, but that’s what makes it a sacrifice.

Have a plan for when things get bad, because at some point, they will.  People get fired, hearts get broken, and sometimes people leave us forever.  Develop a plan to get through these major life challenges- without the use of drugs-before they happen.

Do not become complacent with your sobriety.  If you someday consider having “just a glass of wine”, don’t make the decision lightly.  If you have struggled with addiction in the past, you are much more likely to develop an addiction again.

If you do relapse, don’t give up.  A lot of people find it helpful to keep track of how long they’ve been sober, but don’t confuse this count with the true goal of leading a good life.  If you are at day 100 of sobriety, that’s great.  However, if you make a mistake and end up back at day 0, know that you are not starting over (you gained knowledge, experience, and confidence).  In other words:  Slipping is not a license to go on a binge.

Come up with new rituals.  How do you celebrate holidays, special events, or any other happy occasion?  If your answer includes any sort of drug or acting out, you will want to get creative and figure out something new.  Go wild with a hobby for the day, treat yourself to a nice dinner, or take a trip.  Make sure it is something you get excited about.

During this stressful time, many people are struggling with relapse.  When relapse occurs, people may have feelings of shame or regret.  They might feel like giving up.  These are normal reactions to relapse.  The sooner a person recognizes relapse, the easier it will be to get back on track.

Using the Just for Today Meditation to Manage Change

Self Help addiction groups such as Alcoholics Anonymous, Narcotics Anonymous, and Sex Addictions Anonymous, often use daily meditations to help remind members to stay focused on sobriety.  The “Just for Today” meditation is one of these popular meditations.  It reminds people that we have choices.  We cannot control changes that occur in our lives, but we can choose how to respond to changes.  During stressful times, it may be helpful to remind ourselves of these principles.  The following is a version of this mediation:

Just for Today

Just for Today I will try to live through this day only, not tackling my whole life problems at once.  I can do something at this moment that would bother me if I felt that I had to keep it up for a lifetime.

Just for Today I will try to be happy realizing that my happiness does not depend on what others do or say, or what happens around me.  Happiness is a result of being at peace with myself.

Just for Today I will try to adjust myself to what is and not force everything to adjust to my own desires.  I will accept my family, friends, my business, my circumstances as they come.

Just for Today I will take care of my physical, intellectual, and spiritual health.

Just for Today I will do an act of service for someone else without being found out.  If anyone finds out about it, it will not count.  I will do at least one thing I do not want to do, and I will perform an act of love for my neighbor.

Just for Today I will try to go out of my way to be kind to someone I meet; I will be friendly and act appropriately, I will dress becomingly, talk low, be courteous and not critical, I will not try to control situations or other people.

Just for Today I will have a program.  I may not follow it perfectly, but I will have it.

Just for Today I will stop saying, “if I had time”.  I will never “find time” for anything.  I will have to take time.

Just for Today I will make time to meditate and seek serenity, truth, and acceptance of myself and others.

Just for Today I shall be unafraid.  Particularly, I shall be unafraid to be happy, to enjoy what is beautiful, and what is lovely in life.

Just for Today I will accept myself and live to the best of my ability.

Just for Today I choose to believe that I can live this one day.

When people are struggling with stress and change, they can lose sight of recovery.  It is important to renew ourselves physically, intellectually, and spiritually often.  Considering the Just for Today meditation can help with this endeavor.

 

 

 

 

 

 

 

 

 

Focus on the Five Love Languages

This month I want to focus on Dr. Gary Chapman’s book, The Five Love Languages.  Dr. Chapman says every person has an “emotional tank” waiting to be filled with love.  He indicates there are five ways that people speak and understand emotional love.  The following is a list of the five love languages.  Dr. Chapman indicates that each person may have more than one love language and within each of the love languages there are many dialects.

Five Love Languages

1. Words of Affirmation – this includes encouraging words, compliments, kind tone of voice, making requests rather than demands, and expressing appreciation.
2. Quality Time – this language consists of quality conversations (using listening skills), sympathetic listening, giving undivided attention, quality activities like going for a walk, listening to music, picnicking, gardening, shopping, or taking a vacation together.
3. Receiving Gifts – encompasses gifts of money (the gifts do not necessarily need to be expensive) or of self (being there when your partner needs you).
4. Acts of Service – Doing things you know your partner would like you to do (e.g. walk the dog, wash the dishes, clean the car, rake leaves). With this language, you seek to please your partner.
5. Physical Touch – holding hands, kissing, embracing, massage, sexual intercourse are all ways of communicating emotional love to one’s partner.

Note:  Dr. Chapman believes that physical touch can make or break a relationship.  It can communicate love or hate.  To the person whose primary love language is physical touch, the message projected through touch will be far louder than the words “I hate you” or “I love you.”

Dr. Chapman says that relationships develop better when we understand each other.  He believes that focusing on the five love languages give us important insights into the ways we all express and experience the emotion of love.