Detailed information on paying for alternative treatments, alternative remedies for mental health conditions.

On this page

1. What is CAM?
2. How do patients pay for CAM treatments delivered by a practitioner?
3. How can I find out if there are any laws in my state about insurance coverage of a CAM modality (treatment) that I am interested in?
4. I have health insurance. If I am interested in obtaining treatment from a CAM practitioner, what financial questions should I ask?
5. What financial questions should I ask the practitioner?
6. What about CAM insurance coverage that may be offered through employers?
7. Does NCCAM have a list of insurance companies that cover CAM?
8. My insurer has asked me for evidence, from scientific and medical literature, about the use of a CAM treatment. Can NCCAM provide this information?
9. My insurance company has denied my claim for CAM treatment. Is there anything I can do?
10. Are there laws to help me keep my health insurance if I lose or change jobs? Do these laws apply to CAM treatments?
11. What are tax-exempt accounts for medical expenses? How might they help me?
12. Does the Federal Government have resources that might help me financially with my health-related expenses?
13. Are CAM services deductible on my income tax?
14. Can you suggest any other resources?
15. Resources

Consumers of health care, including complementary and alternative medicine (CAM), often have questions about the financial aspects of obtaining treatment. This fact sheet addresses a number of frequently asked questions about consumer financial issues in CAM and includes resources for further information.

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1. What is CAM?

CAM, as defined by the National Center for Complementary and Alternative Medicine (NCCAM), is a group of diverse medical and health care systems, practices, and products that are not presently considered part of conventional medicine. ¹Complementary medicine is used together with conventional medicine. Alternative medicine is used in place of conventional medicine. To find out more about these terms, consult the NCCAM fact sheet "What Is Complementary and Alternative Medicine?" (See "Resources.")

NCCAM is the Federal Government's lead agency for research on CAM. NCCAM is dedicated to exploring CAM healing practices in the context of rigorous science, training CAM researchers, and disseminating authoritative information to the public and professionals.

¹Conventional medicine is medicine as practiced by holders of M.D. (medical doctor) or D.O. (doctor of osteopathy) degrees and by allied health professionals, such as physical therapists, psychologists, and registered nurses. Other terms for conventional medicine include allopathy; Western, mainstream, orthodox, and regular medicine; and biomedicine. Some conventional medical practitioners are also practitioners of CAM.

2. How do patients pay for CAM treatments delivered by a practitioner?

In CAM, as in conventional medicine, there are two primary ways people pay for care.

• Out-of-pocket payment. Most consumers must pay for CAM practitioner services and CAM therapeutic products themselves.

• Insurance. Some health plans offer some coverage of CAM. Such coverage tends to be very limited, however, and varies considerably from state to state.

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3. How can I find out if there are any laws in my state about insurance coverage of a CAM modality (treatment) that I am interested in?

There is no one central resource that collects this information for all the states. Some resources that may be helpful include:

• If you are seeking CAM treatment from a practitioner, there is likely to be one or more national professional associations for practitioners of that treatment--for example, associations for chiropractors. Many of these organizations monitor insurance coverage and reimbursement for their specialty. You can locate organizations by trying an Internet search or asking a reference librarian for assistance.

• Each of the 50 states, as well as the District of Columbia and the four U.S. territories, has an agency that regulates the insurance industry in that state, enforces insurance laws, and assists consumers. This agency is often called the office of the state insurance commissioner (see "Resources"). The services that this office provides vary by state, but each handles consumer inquiries. Your commissioner's office may be able to inform you of any requirements in your state for insurance coverage of a specific CAM modality.

4. I have health insurance. If I am interested in obtaining treatment from a CAM practitioner, what financial questions should I ask?

First, you need to be informed about your health insurance plan. Does it offer any coverage of CAM treatments? If so, what are the requirements and limits--for example, does the plan limit the conditions it will cover, require that CAM services be delivered by specific practitioners (such as a licensed medical doctor or a practitioner in the company's network), or cover only services that the plan determines to be medically necessary? Read your plan carefully, including the limits and exclusions. You may also want to check with the insurance company before you seek treatment.

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Here are some questions to ask your insurer:

• Does this care need to be preauthorized or preapproved?

• Do I need a referral from my primary care provider? ²

• What services, tests, or other costs will be covered?

• How many visits are covered and over what period of time?

• Is there a copayment?

• Will the therapy be covered for any condition or only for certain conditions?

• Will any additional costs (for example, laboratory tests, dietary supplements, equipment, or supplies) be covered?

• Will I need to see a practitioner in your network? If so, can you provide me with a list of practitioners in my area?

• If I use a practitioner who is not part of your network, do you provide any coverage? Are there any additional out-of-pocket costs?

• Are there any dollar or calendar limits to my coverage?

It will help you if you keep organized records about all interactions with your insurance company. Keep copies of letters, bills, and claims. Make notes about calls, including the date, time, customer service representative's name, and what you were told. If you are not satisfied with a representative's explanations, ask to speak to someone else.

²If the insurance company requires you to have a referral, be sure to obtain it and take it with you to the practitioner. It is also a good idea to keep a copy for your records.

 

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5. What financial questions should I ask the practitioner?

Here are some questions to ask the practitioner or his office staff:

• Do you accept my health insurance?

• Do I file the claim forms, or do you (the provider) take care of that?

• What is the cost for an initial appointment?

• How many treatments will I need?

• How much will each treatment cost?

• Can I receive treatment for a trial period to see if the therapy works for me before I commit to a full course?

• Will there be any additional costs?

It can also be useful to ask which insurance plans the practitioner accepts, in case you become interested in changing plans at some point (for example, through a change of employment).

If you do not have insurance coverage for treatment, and paying the full fee each time would be difficult for you, you might ask:

• Can your office arrange a payment plan so that my costs are spread out over a longer period of time?

• Do you offer a sliding-scale fee? (A sliding-scale fee adjusts charges based on a patient's income and ability to pay.)

For more information on seeking treatment from a practitioner, consult the NCCAM fact sheet "Selecting a Complementary and Alternative Medicine (CAM) Practitioner." (See "Resources.")

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6. What about CAM insurance coverage that may be offered through employers?

If CAM coverage is offered, it is usually one of the following types:

• Higher deductibles. A deductible is a total dollar amount that the consumer must pay before the insurer begins making payments for treatments. Under this type of policy, CAM coverage is offered, but the consumer pays a higher deductible.

• Policy riders. A rider is an amendment to an insurance policy that may change coverage in some way (such as increasing or decreasing benefits). You may be able to purchase a rider that adds or expands coverage in the area of CAM.

• A contracted network of providers. Some insurers work with a group of CAM providers who agree to offer services to group members at a rate lower than that offered to nonmembers. You pay out of pocket for treatment, but at a discounted rate.

Employers negotiate with insurance companies for plan rates and services. This is done on a periodic basis (usually annually). You may wish to let your company's benefits administrator know about any coverage preferences you have. If your company offers more than one plan, evaluate carefully what each one offers, so you can pick the plan that best meets your needs.

The Agency for Healthcare Research and Quality (AHRQ), a Federal agency, has helpful publications about choosing and using a health insurance plan (see "Resources").

7. Does NCCAM have a list of insurance companies that cover CAM?

As a medical research organization, NCCAM does not collect this kind of information and, therefore, does not have a list of companies that cover CAM. The following suggestions may be helpful:

• Talk to your family members, friends, and coworkers about their experiences with insurance companies and plans.

• Check what your state insurance commissioner's office (see Question 3) has to offer. Many provide consumer publications, such as summaries of basic information about the health insurance companies operating in the state and/or ratings of those companies. Note that commissioners' offices do not provide recommendations or advice on specific companies.

• An insurance broker (an agent who sells policies for a variety of companies) may also be a resource.

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8. My insurer has asked me for evidence, from scientific and medical literature, about the use of a CAM treatment. Can NCCAM provide this information?

The NCCAM Clearinghouse can help you find information from the scientific and medical literature on CAM. They use databases of peer-reviewed scientific and medical journals, such as CAM on PubMed (see "Resources"). If you do not have access to the Internet, the Clearinghouse can send information to you.

9. My insurance company has denied my claim for CAM treatment. Is there anything I can do?

As discussed in Question 3, make sure you know your policy--including what it is, and is not, supposed to cover. Check whether there has been a coding ³ error, either by the practitioner's office or by the insurance company; compare the codes on the practitioner's bill with the codes on the document you received from the insurance company. If you think your insurer made a mistake processing your claim, you can request a review from the company. Also, the insurance company should have an appeal procedure and provide a copy of it with your policy. It may be helpful to discuss with your practitioner whether she can do anything on your behalf, such as writing a letter. If you have taken these steps and the problem is not resolved, contact your state insurance commissioner's office, which has consumer complaint procedures.

³Health care providers and insurance companies use a standard set of codes in billing for medical services.

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10. Are there laws to help me keep my health insurance if I lose or change jobs? Do these laws apply to CAM treatments?

If you currently have an insurance plan that includes any CAM coverage, the following laws may be of interest to you.

The Health Insurance Portability and Accountability Act (HIPAA) of 1996 offers limited protections for many employed Americans. HIPAA protects health insurance coverage for workers and their families if the worker changes or loses his job. The law:

• Limits the ability of insurance companies to refuse coverage based on preexisting conditions.

• Prevents group health plans from denying or charging more for coverage because of past or present poor health.

• Assures renewal of coverage, regardless of any health conditions of people covered under the policy.

• Guarantees certain small-business employers, and certain people who lose job-related coverage, the right to buy health insurance.

The Centers for Medicare & Medicaid Services (see "Resources") can provide you with general information on the Federal HIPAA program. Note that individual states may have specific laws related to HIPAA requirements; if you need more information on HIPAA in your state, contact your state insurance commissioner's office.

Another Federal law that may help you is the Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1985. COBRA continuation coverage gives you the chance to buy and maintain your current group health coverage for a defined period of time if you are laid off or have your work hours reduced below the level for receiving benefits. The length of continuation coverage depends on the reason for your loss of group coverage. COBRA generally covers health plans of businesses with 20 or more employees, employee organizations, and state or local governments. You must meet certain application deadlines and other conditions, such as payment schedules, to maintain coverage under COBRA. COBRA also can help you avoid a gap in coverage if you change jobs and are not immediately eligible for coverage in your new company.

For more information about COBRA, contact your nearest office of the Pension and Welfare Benefits Administration of the Department of Labor (see "Resources"). Your state may also have a law that requires insurers to continue group plan coverage to individuals who lose their medical coverage for various reasons. Check with your state insurance commissioner's office.

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11. What are tax-exempt accounts for medical expenses?

How might they help me? A flexible spending arrangement (FSA; sometimes called a Flexible Spending Account) is a benefit provided by some employers that offers a way to help pay for out-of-pocket medical expenses, while reducing the employee's taxable income. With FSAs for health-related expenses, you choose an amount of pre-tax dollars to be set aside from your paycheck each pay period. This money is then available to reimburse certain health-related expenses that are not paid any other way, such as by insurance. You may need to supply documentation from a physician or other health care provider that the treatment is medically necessary. Note that the IRS does not allow the same expense(s) to be both reimbursed through an FSA and claimed as a tax deduction (see Question 13).

Another type of tax-exempt benefit for health-related expenses is a health savings account (HSA). Set up by Congress in December 2003, HSAs allow some individuals who participate in a high-deductible health plan to save money in a tax-free account. If you are eligible, you can use these savings to pay for your future medical expenses or those of your spouse or dependents.

The IRS has publications with more information about FSAs and HSAs. The Department of the Treasury also has a direct link to information about HSAs on its Web site. See "Resources" below for details.

12. Does the Federal Government have resources that might help me financially with my health-related expenses?

Currently, Federal health assistance programs are not set up to assist with CAM expenses specifically. They are intended to provide either direct support (direct payments) or indirect support (such as housing or child care credits, medical care at public clinics, or other social services) to people whom the Government determines to be in need. Examples include people who:

• Have a low income and limited resources.

• Do not have other medical insurance.

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  Have a disability.

• Are part of a population that has difficulty accessing medical care.

• Are at least 65 years of age.

• Have served in the military.

There are Federal databases on the Internet that can introduce you to these programs. GovBenefits (www.govbenefits.gov) provides an overview and a self-test to help you identify whether any benefits are appropriate for your needs. FirstGov (www.firstgov.gov) has information on various health-related programs such as Medicare and Medicaid. FirstGov also has a database with information on benefits for seniors, www.firstgov.gov/Topics/Seniors.

The Social Security Administration (see "Resources") has two programs that pay benefits to people with disabilities:

• Social Security Disability Insurance (SSDI) pays benefits to disabled workers who have paid into Social Security through payroll deductions and to certain family members.

• Supplemental Security Income (SSI) pays benefits to people who are elderly or disabled and have low incomes.

The Department of Veterans Affairs (see "Resources") may be able to help with health care costs if you or a family member served in the Armed Forces. Certain CAM treatments may be covered, such as chiropractic and acupuncture.

The Health Resources and Services Administration (HRSA, see "Resources") has several programs:

• While this program is not CAM-specific, the Hill-Burton program requires health care facilities (usually hospitals and clinics) that received certain Federal funding to provide a specific amount of health care to needy persons free or at reduced cost. Eligibility is determined by income and family size, using the Federal poverty guidelines.

• Through its Bureau of Primary Health Care (BPHC), HRSA funds community and migrant health care centers that treat people with limited access to medical services. Depending on the needs of the community, CAM care may be integrated with conventional care at these centers.

• Through the national "Insure Kids Now!" initiative, each state has a program to make health insurance available to infants, children, and teens in working families.

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The Centers for Medicare & Medicaid Services (see "Resources"), formerly the Health Care Financing Administration, administers the Medicare and Medicaid programs:

• Medicare is insurance for older persons and persons with disabilities. As of 2002, it includes some limited coverage of chiropractic services. Other CAM insurance coverage is under consideration.

• Medicaid, a joint Federal-state program, is for people who need financial assistance for medical expenses. States may choose to provide optional Medicaid health care services, which could include CAM, in addition to required Medicaid services.

Also available through the Centers for Medicare & Medicaid Services is the State Children's Health Insurance Program, which expands health coverage to uninsured children in working families that earn too much for Medicaid but too little to afford private coverage.

The Federal Government also provides states and communities with various funds to assist needy persons, including for medical care. To find out more about these benefits and whether you are eligible, contact your state or local department of social services. These departments are listed in the "Government" section of your phone book.

Some persons have inquired whether they can receive CAM treatments or financial assistance for treatments from NCCAM. Given its mission of research, training, and disseminating information, NCCAM does not provide financial assistance or treatment to consumers. As part of its research, NCCAM does conduct clinical trials of some CAM treatments (to find out more, go to nccam.nih.gov/clinicaltrials, or contact the NCCAM Clearinghouse; see "Resources").

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13. Are CAM services deductible on my income tax?

As of 2002, the IRS allows a limited number of deductibles for CAM services and products (see "Resources"). Top

14. Can you suggest any other resources?

If treatment (whether CAM or conventional) for a disease or condition creates a financial crisis for you and your family, you may wish to try the following for more information:

• If you receive care at a hospital or clinic, that facility may have a social worker or patient advocate who can advise you.

• You may also find it helpful to contact nonprofit organizations that work on your disease or medical condition (try an Internet search or check directories at your local library).

15.Resources

Web sites for the resources below are given where available, but you may also call or write for information.

NCCAM Clearinghouse

Toll-free in the U.S.: 1-888-644-6226
International: 301-519-3153
TTY (for deaf or hard-of-hearing callers): 1-866-464-3615

E-mail: info@nccam.nih.gov
Web site: www.nccam.nih.gov
Address: NCCAM Clearinghouse,
P.O. Box 7923,
Gaithersburg, MD 20898-7923
Fax: 1-866-464-3616
Fax-on-Demand service: 1-888-644-6226

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Agency for Healthcare Research and Quality (AHRQ)

AHRQ conducts research on health care outcomes, quality, cost, use, and access. AHRQ's publications for consumers, including "Choosing and Using a Health Plan" and "Checkup on Health Insurance Choices," are located at www.ahrq.gov/consumer/index.html#plans .

Toll-free in the U.S.: 1-800-358-9295
TTY (for deaf and hard-of-hearing callers): 1-888-586-6340
Web site: www.ahrq.gov
E-mail: info@ahrq.gov

CAM on PubMed

CAM on PubMed, a database developed jointly by NCCAM and the National Library of Medicine, offers citations to (and in most cases, breif summaries of) articles on CAM in scientically based, peer-reviewed journals. CAM on PubMed also links to many publisher Web sites, which may offer the full text of articles.

Web site: www.nlm.nih.gov/nccam/camonpubmed.html

Centers for Medicare & Medicaid Services (CMS)

CMS, formerly the Health Care Financing Administration, administers the Medicare and Medicaid programs. Contact the above to be referred to your nearest regional office. CMS has publications on these programs, including the HIPAA law.

Toll-free in the U.S.: 1-877-267-2323
Web site: www.cms.hhs.gov

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Department of Labor (DOL)

The DOL has informational pamphlets and other materials concerning Federal health care laws, including the HIPAA and COBRA laws.

The DOL Pension and Welfare Benefits Administration Web site has many publications. Go to www.dol.gov/pwba or call the toll-free number below.

Toll-free in the U.S.: 1-866-4-USA-DOL (1-866-487-2365)
TTY (for deaf or hard-of-hearing callers): 1-877-889-5627
Web site: www.dol.gov

Department of the Treasury

The Department's Office of Public Affairs has information on HSAs, including press releases and links to other resources. A representative can be reached 24 hours a day by calling 202-622-2960. Questions can also be submitted by e-mail to HSAinfo@do.treas.gov.

Telephone: 202-622-2000
Web site: www.ustreas.gov

Department of Veterans Affairs (VA)

The VA is responsible for providing Federal benefits to veterans of the Armed Forces and their dependents. With regard to CAM, as of 2002, coverage decisions for chiropractic were being made on a regional basis, and there had been some coverage of acupuncture in the preceding few years. For more information, contact your local VA health facility, or the Tricare Military Health System at www.tricare.osd.mil.

Toll-free in the U.S.: 1-877-222-8387
TTY (for deaf or hard-of-hearing callers): 1-800-829-4833
Web site: www.va.gov/health_benefits

Health Resources and Services Administration (HRSA)

Contact HRSA for more information about its programs and a referral to your nearest HRSA field office.

• For information about the Hill-Burton program, you can go to www.hrsa.gov/osp/dfcr/obtain/obtain.htm or call 1-800-638-0742.

• For information about or referrals to HRSA's community and migrant health centers, and other BPHC-funded centers, you can go to www.ask.hrsa.gov/pc.

• HRSA administers the "Insure Kids Now!" campaign. To be referred to the program in your state, go to www.insurekidsnow.gov/states.htm or call toll-free 1-877-543-7669.

Toll-free in the U.S.: 1-888-ASK-HRSA (1-888-275-4772)
Web site: www.hrsa.gov
E-mail: ask@hrsa.gov

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Insurance Commissioners' Offices

To locate the insurance commissioner's office for your state (or for D.C. or the U.S. Territories):
(1) If you have access to the Internet, go to www.consumeraction.gov/insurance.shtml.
(2) If you don't have access to the Internet, consult the "State Government" section of your phone book or inquire with directory assistance. Note that the insurance commissioner or regulator's office can have different names in different states, such as the [Name of State] Insurance Administration (or Division or Department). Each office has a toll-free consumer assistance number.

Internal Revenue Service (IRS)

The IRS is the nation's tax collection agency. Publications include:

• "Introduction to Cafeteria Plans," which includes a chapter on FSAs. This document is online at:
  www.irs.gov/pub/irs-utl/intro_to_cafeteria_plans_doc.pdf.

• Publication 553, "Highlights of 2003 Tax Changes," which was revised in January 2004 and includes information on HSAs. This document is online at www.irs.gov/pub/irs-pdf/p553.pdf.

• Publication 502, "Medical and Dental Expenses," on tax deductions for medical costs. This document is online at www.irs.gov/pub/irs-pdf/p502.pdf. As of 2003, potentially deductible costs include some CAM therapies such as acupuncture, chiropractic, and osteopathy.

Toll-free in the U.S.: 1-800-829-1040
Web site: www.irs.ustreas.gov

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Social Security Administration (SSA)

The SSA administers benefits under two programs, the Social Security Disability Insurance (SSDI) Program and the Supplemental Security Income (SSI) Program.

Toll-free in the U.S.: 1-800-772-1213
TTY (for deaf or hard-of-hearing callers): 1-800-325-0778
Web site: www.ssa.gov

NCCAM has provided this material for your information. It is not intended to substitute for the medical expertise and advice of your primary health care provider. We encourage you to discuss any decisions about treatment or care with your health care provider. The mention of any product, service, or therapy in this information is not an endorsement by NCCAM.

next: Important Information About Herbal Treatments

In: Peele, S., with Brodsky, A. (1975), Love and Addiction. New York: Taplinger.

© 1975 Stanton Peele and Archie Brodsky.
Reprinted with permission from Taplinger Publishing Co., Inc.

A. Responses to Morphine and a Placebo

In the Lasagna experiment, patients were given injections of an allegedly pain-killing drug which was sometimes morphine and sometimes a placebo. The drugs were administered under double-blind conditions; that is, neither the patients nor the technicians who administered the drugs knew which was which. Depending on the sequence of administration of the two drugs, which was varied in several ways, between 30 and 40 percent of the patients found the placebo as adequate as the morphine. Those who believed in the efficacy of the placebo also were somewhat more likely to obtain relief from the morphine itself. The average percentage of times relief was obtained from morphine by those who never responded to the placebo was 61 percent, while for those who did accept the placebo at least once, it was 78 percent.

B. Shared Action of Chemically Distinct Substances

In grouping barbiturates, alcohol, and opiates into one category, we depart, of course, from a strictly pharmacological approach to drugs. Since these three kinds of drugs have different chemical structures, a pharmacological model cannot explain the fundamental similarities in people's reactions to them. Consequently, many biologically oriented researchers have attempted to discount such similarities. Foremost among these scientists is Abraham Wikler (see Appendix F), whose position may have ideological overtones. It is consistent, for instance, with the importance he gives physiological habituation in his reinforcement model of addiction, and with the conservative public position he has maintained on such issues as marijuana. However, nowhere have pharmacologists been able to demonstrate a link between the particular chemical structures of the major depressants and the unique addictive properties that Wikler believes each of them has. In any case, there are other biochemical researchers who claim, as do Virginia Davis and Michael Walsh, that "Because of the resemblance of symptoms occurring on withdrawal of either alcohol or the opiates, it seems possible that the addictions may be similar and that the real distinctions between the two drugs could be only the length of time and dosage required for development of dependence."

Generalizing from Davis and Walsh's argument, differences in the effects of many drugs are perhaps more quantitative than qualitative. Marijuana, for instance, would have small potential for addiction simply because it is too mild a sedative to engage fully a person's consciousness in the manner of heroin or alcohol. Even these quantitative distinctions may not always be intrinsic to the drugs in question, but may be strongly influenced by the dosage strengths and methods of administration that are characteristically employed with these drugs in a given culture. The Bushmen and Hottentots may have reacted violently to smoking tobacco because they swallowed the smoke rather than exhaling it. Coffee and tea may be prepared in milder concentrations in present-day America than in nineteenth-century England. Smoking a cigarette may provide a small and gradual infusion of nicotine, compared to the amount of heroin one gets from injecting a strong dose directly into the bloodstream. These circumstantial differences are not inconsiderable, and should not be mistaken for categorical differences between substances which in important respects operate similarly.

C. Effects of Expectations and Setting on Reactions to a Drug

Subjects in the Schachter and Singer study received an injection of the stimulant epinephrine (adrenalin), which was presented to them as an "experimental vitamin." Half of the subjects were told what to expect from the injection (i.e., generalized arousal); the other half were kept in the dark about these "side effects" of the supposed vitamin. Then each subject was left in a room with another person—a stooge paid by the experimenter to act in a specified way. Half the subjects in each of the original two groups were exposed, individually, to a stooge who acted as though he were euphoric, joking and throwing paper around, and half were put in with a stooge who took offense at the experiment and stalked out in anger. The result was that uninformed subjects—those who had not been told what their physiological reaction to the injection was going to be—picked up the mood set by the stooge, while informed subjects did not. That is, if the subject experienced an effect from the drug, but didn't know why he was feeling that way, he became very suggestible. Seeing the stooge react to the experiment in a certain way served to explain for the subject why he himself was physiologically aroused—i.e., that he was angry, or that he was euphoric. On the other hand, if the subject could link his physiological state with the injection, then he had no need to look around him for an emotional explanation for his arousal. Another group of subjects, who were grossly misinformed about what the injection would do to them, were even more suggestible than were uninformed subjects.

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To investigate what happens generally when people mislabel the drug they take, or anticipate effects that actually are characteristic of a different kind of drug, Cedric Wilson and Pamela Huby gave subjects three classes of drugs: stimulants, depressants, and tranquilizers. "When the subjects guessed correctly which drug they had received," reported Wilson and Huby, "they responded to it vigorously. When they guessed incorrectly, the effects of the drug were partially or completely inhibited."

D. Comparison of Health Hazards of Commonly Used Drugs with Those of Heroin

The major health hazards of tobacco are in the areas of lung cancer, emphysema, chronic bronchitis, and heart disease. Coffee, according to Marjorie Baldwin's article "Caffeine on Trial," is being implicated in heart disease, diabetes, hypoglycemia, and stomach acidity. In addition, recent research has concentrated on the increased incidence of birth defects and increased risks in pregnancy with both of these drugs, as well as with aspirin. The U.S. Public Health Service has reported that smoking on the part of mothers is an important contributor to the high rate of fetal mortality in this country. Lissy Jarvik and her colleagues, investigating chromosomal damage from LSD (see Appendix E), find that long-time aspirin users and "coffee or Coca-Cola addicts" run similar risks of genetic damage and congenital abnormality in their offspring, and women who take aspirin daily are now being observed to show a higher than normal rate of irregularities in pregnancy and childbirth.

While American society has been slow in recognizing the deleterious consequences of these familiar drugs, it has from the outset exaggerated those of heroin. Along with the myths of addiction after one shot (for which only a psychological explanation is possible) and unlimited tolerance, heroin is thought to lead to physical degeneration and death. But the experience of lifetime users in favorable social climates has shown that heroin is as viable a habit to maintain as any other, and medical research has not isolated any ill effects on health from heroin use alone. The main cause of illness and death among street addicts is contamination from unhealthy conditions of administration, such as dirty hypodermic needles. The addict's lifestyle also contributes in many ways to his high mortality rate. Charles Winick has concluded, "Opiates usually are harmless, but they are taken under unsatisfactory conditions. Malnutrition caused by loss of appetite probably is the most serious complication of opiate addiction."

The physical danger that heroin is most widely believed to present for its users is that of death by overdose. Constituting perhaps the most persistent misapprehension about the drug, "heroin overdoses" have vastly increased in recent years while the average heroin content in doses available on the street has been shrinking. Citing an investigation by Dr. Milton Helpern, New York City's Chief Medical Examiner, Edward Brecher shows that so-called deaths by OD could not possibly result from that cause. The best current guess is that deaths attributed to overdosing are actually due to the use of heroin in combination with another depressant, such as alcohol or a barbiturate.

The information presented here is not intended as an argument favoring the use of heroin. In fact, it is true that heroin offers the most sure and complete chance for eradicating one's consciousness, which is the basic element in an addiction. The premise of this book is that addiction as a way of life is psychologically unhealthy both in its causes and consequences, and the values which the book is meant to encourage run directly counter to those of a drugged or otherwise artificially supported existence. The exculpatory data on heroin, together with the evidence of ill effects from cigarettes and coffee, are offered in support of the proposition that a culture's—our culture's—estimate of the physical as well as psychological hazards of different drugs is an expression of its overall attitude toward those drugs. What must be dealt with is our society's need to condemn heroin from every possible angle, regardless of the facts, even while that society is so strongly susceptible to heroin and other forms of addiction.

E. LSD Research

Sidney Cohen's study was based on a survey of 44 LSD researchers who, among them, had collected data on 5000 individuals who had been given LSD or mescaline on a total of 25,000 occasions. These subjects, broken down into "normal" experimental volunteers and patients undergoing psychotherapy, showed the following rates of complications associated with hallucinogenic trips: attempted suicides—0 per 1000 for normal subjects, 1.2 per 1000 for psychiatric patients; psychotic reactions lasting longer than 48 hours (roughly the duration of a trip)—less than 1 per 1000 for normal subjects, less than 2 per 1000 for psychiatric patients.

The refutation of the Maimon Cohen study on chromosomal breakage caused by LSD focused on the fact that the study employed human leukocytes (white blood cells) cultured artificially in a test tube (in vitro), rather than in the living organism (in vivo). Under these conditions, where the cells cannot easily rid themselves of toxins, many chemicals cause increased chromosomal breakage. These include aspirin, benzene, caffeine, antibiotics, and even more innocuous substances, such as water that has not been twice distilled. Subsequent in vivo studies of users of pure and illicit LSD, along with further in vitro studies with proper controls, showed that there is no special danger with LSD. Reporting that caffeine doubles breakage rates just as LSD does, Jarvik and her colleagues note that any substance introduced into the body in sufficient quantity during gestation can cause congenital abnormality.

F. Conditioning Models of Addiction

A major line of thought in addiction research—the conditioned learning approach of Abraham Wikler and the animal experimenters at the University of Michigan (see Appendix B)—is explicitly concerned with the psychological rewards and punishments associated with drug use. The chief limitation of this theorizing and research, however, is that it takes withdrawal distress for granted and assumes that the relief of withdrawal pain is invariably the addict's primary reinforcement for taking an opiate past the period of initial involvement with the drug. Other rewards (such as those provided by environmental stimuli) are considered, but only as secondary reinforcements that are linked to the relief of withdrawal.

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The mechanistic character of conditioning theories is associated with their origins in the observation of laboratory animals. Human consciousness entails a greater complexity of response to drugs, and withdrawal, than animals are capable of. Only animals respond to drugs in a predictable way, and only animals (especially encaged animals) respond uniformly to the onset of withdrawal by renewing their dosage of a drug. For a conditioning theory to explain the behavior of human addicts, as well as nonaddicted drug users, it must take into account the various social and personal reinforcements— ego-gratification, social approval, security, self-consistency, sensory stimulation, etc.—that motivate human beings in their drug-taking as in other activities.

Recognizing the limitations of animal-based hypotheses, Alfred Lindesmith has proposed a variation of conditioning theory which adds to it an important cognitive dimension. In Addiction and Opiates, Lindesmith argues that addiction occurs only when the addict understands that physiological habituation to morphine or heroin has taken place, and that only another dose of the drug will protect him from withdrawal. Despite Lindesmith's insistence that addiction is a conscious, human phenomenon, his theory is just as narrowly based on physical dependence and withdrawal as all-purpose reinforcers as are other conditioning models. It posits only one kind of cognition (i.e., the awareness of an association between withdrawal and taking an opiate) as influencing the psychological process of conditioning, rather than allowing for the range of cognitions of which human beings are capable. Lindesmith notes marginally that hospital patients who know that they have received morphine, and who are knowingly withdrawn from the drug, still do not usually become addicted. This is because they think of themselves as patients, not addicts. Lindesmith fails to draw what seems a reasonable inference from this observation: that self-image is always a factor to be considered in the addiction process.

G. Physiological and Psychological Mechanisms of Addiction

The publication in Science of a study by Louise Lowney and her colleagues on the binding of opiate molecules in the brains of mice, which is part of an ongoing line of research in that area, has convinced many people that a breakthrough has been achieved in understanding addiction physiologically. But for every study of this sort that reaches the public eye, there is also one like Psychology Today's report on Richard Drawbaugh and Harbans Lal's work with morphine-addicted rats who had been conditioned to accept the ringing of a bell (together with a placebo injection) in place of morphine. Lal and Drawbaugh found that the morphine antagonist naloxone, which is presumed to counteract the effects of morphine chemically, inhibited the effects of the conditioned stimulus (the bell) as well as those of morphine itself. Clearly, the antagonist was working at something besides a chemical level.

Chemical reactions in the brain can, of course, be observed whenever a psychoactive drug is introduced. The existence of such reactions, and the fact that all psychological processes ultimately take the form of neural and chemical processes, should not be used to beg the questions raised by the impressive array of research, observations, and subjective reports that testify to the variability of human reactions to drugs.

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References

Baldwin, Marjorie V. "Caffeine on Trial." Life and Health (October 1973): 10-13.

Brecher, Edward M. Licit and Illicit Drugs. Mount Vernon, N.Y.: Consumers Union, 1972.

Cohen, Maimon M.; Marinello, Michelle J.; and Back, Nathan. "Chromosomal Damage in Human Leukocytes Induced by Lysergic Acid Diethylamide." Science 155 (1967): 1417-1419.

Cohen, Sidney. "Lysergic Acid Diethylamide: Side Effects and Complications." Journal of Nervous and Mental Disease 130 (1960): 30-40.

Davis, Virginia E., and Walsh, Michael J. "Alcohol, Amines, and Alkaloids: A Possible Biochemical Basis for Alcohol Addiction." Science 167 (1970): 1005-1007.

Dishotsky, Norman I.; Loughman, William D.; Mogar, Robert E.; and Lipscomb, Wendell R. "LSD and Genetic Damage." Science 172 (1971): 431-440.

Drawbaugh, Richard, and Lal, Harbans. "Reversal by Narcotic Antagonist of a Narcotic Action Elicited by a Conditioned Stimulus." Nature 247 (1974): 65-67.

Jarvik, Lissy F.; Kato, Takashi; Saunders, Barbara; and Moralishvili, Emelia. "LSD and Human Chromosomes." In Psychopharmacology: A Review of Progress 1957-1967 edited by Daniel H. Efron, pp. 1247-1252. Washington, D.C.: Public Health Service Document No. 1836; HEW, 1968.

Lasagna, Louis; Mosteller, Frederick; von Felsinger, John M.; and Beecher, Henry K. "A Study of the Placebo Response." American Journal of Medicine 16 (1954): 770-779.

Lindesmith, Alfred R. Addiction and Opiates. Chicago: Aldine, 1968.

Lowney, Louise I.; Schulz, Karin; Lowery, Patricia J.; and Goldstein, Avram. "Partial Purification of an Opiate Receptor from Mouse Brain." Science 183 (1974): 749-753.

Schachter, Stanley, and Singer, Jerome E. "Cognitive, Social, and Physiological Determinants of Emotional State." Psychological Review 69 (1962): 379-399.

Wikler, Abraham. "Some Implications of Conditioning Theory for Problems of Drug Abuse." In Drug Abuse: Data and Debate, edited by Paul L. Blachly, pp. 104-113. Springfield, Ill.: Charles C Thomas, 1970.

Wilson, Cedric W. M., and Huby, Pamela, M. "An Assessment of the Responses to Drugs Acting on the Central Nervous System." Clinical Pharmacology and Therapeutics 2 (1961): 174-186.

 

Increased levels of depression are associated with those who become addicted to the Internet.

Kimberly S. Young and Robert C. Rodgers

Ed. Note: This paper was published in CyberPsychology & Behavior, 1(1), 25-28, 1998

ABSTRACT

Prior research has utilized the Zung Depression Inventory (ZDI) and found that moderate to severe rates of depression coexist with pathological Internet use.¹ Although the ZDI was utilized for its expediency with on-line administration, its limitations include poor normative data and less frequent clinical use. Therefore, this study utilized the Beck Depression Inventory (BDI), which has more accurate norms and frequent usage among dual diagnostic patient populations. An on-line survey administered on a World Wide Web site utilized the BDI as part of a larger study. A total of 312 surveys was collected with 259 valid profiles from addicted users, which again supported significant levels of depression to be associated with pathological Internet use. This article discusses how a treatment protocol should emphasis the primary psychiatric condition if related to a subsequent impulse control problem such as pathological Internet use. Effective management of psychiatric symptoms may indirectly correct pathological Internet use.

PRIOR RESEARCH HAS IDENTIFIED the existence of addictive Internet use, which has been associated with significant social, psychological, and occupational impairment.² Addicts in this study used the Internet an average of 38 hr per week for nonacademic or nonemployment purposes, which caused detrimental effects such as poor grade performance among students, discord among couples, and reduced work performance among employees. This is compared to nonaddicts who used the Internet an average of 8 hr per week with no significant consequences reported. Predominantly, the interactive capabilities of the Internet such as chat rooms or on-line games were seen to be the most addictive. This type of behavioral impulse control failure, which does not involve an intoxicant, was seen as most akin to pathological gambling. Therefore, a formal term utilized in this article is pathological Internet use (PIU) to refer to cases of addictive Internet use.

Research in the addictions field has shown that psychiatric illnesses such as depression are often associated with alcoholism³ and drug addiction.⁴ Further, research has shown that other addictive behaviors overlap with depression-for example, eating disorders⁵'⁶ and pathological gambling.⁷-⁹ Although the concept of Internet addiction has gained credibility among mental health professionals both in academic and clinical realms, little research has been conducted to examine if similar underlying psychiatric illnesses may contribute to such Internet abuse.¹

Therefore, the objective of this study was to assess depression and compare such results to other established dual diagnostic populations. Young¹ utilized the Zung Depression Inventory¹⁰ (ZDI), which suggested that increased levels of depression are associated with moderate to severe levels of PIU. However, the ZDI yields limited clinical utility; therefore, this study used the Beck Depression Invento#¹ (BDI) because it is a more psychometrically and clinically valid instrument to further investigate the effects of depression on PIU. Finally, this study also attempted to increase its sample size from the previous examination (N -99) to improve generalizability of results.

METHOD

Subjects

Subjects were self-selected active Internet users who responded to postings on electronic support groups and those who searched for the keywords Internet or addiction on popular Web search engines (e.g., Yahoo).

Materials

An on-line survey was constructed for this study. The survey exists as a World Wide Web (WWW) page (located at http: / /www.pitt. edu/ ksy/survey.html) implemented on a UNIX-based server that captures the answers into a text file. The on-line survey administered a structured diagnostic questionnaire that modified the DSM-IV criteria for pathological gambling'² to classify subjects as addicted or nonaddicted, followed by administration of the BDI, the Sixteen Personality Factor Inventory,¹⁵ and Zuckerman's Sensation Seeking Scale,¹³ as part of a larger study. Finally, demographic information was also gathered.

Procedures

The WWW location of the survey was submitted to several popular search engines available to assist on-line users in finding Web pages of interest. On-line users entering keyword searches for Internet or addiction would find the survey and have the option to follow the link to the survey in order to fill it out. Additionally, a brief description of the study along with the WWW address of the survey was advertised on prominent electronic support groups geared toward Internet addiction (e.g., the Internet Addiction Support Group and the Web-aholics Support Group). Answers to the survey were sent in a text file directly to the principal investigator's electronic mailbox for analysis. Respondents who answered "yes" to five or more of the criteria were classified as addicted Internet users for inclusion in this study.

RESULTS

A total of 312 surveys were collected, resulting in 259 valid geographically dispersed profiles from addicted users. The sample included 130 males with a mean age of 31 and 129 females with a mean age of 33. Educational background was as follows: 30% had a high school degree or less, 38% had an associate's or bachelor's degree, 10% had a master's degree or doctorate, and 22% were still in school. Of the subjects, 15% had no vocational background (e.g., homemaker or retired), 31% were students₁ 6% were blue-collar workers (e.g., factor worker or auto mechanic), 22% were nontech white-collar workers (e.g., school teacher or bank teller), and 26% were high-tech white-collar workers (e.g., computer scientist or systems analyst).

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Occupational type appears to be a determinant in the level of Internet usage in this study. These results suggest that nontech or high-tech white-collar workers are more likely to become addicted to the Internet than are blue-collar workers. White-collar employment may offer wider access to the Internet and greater salary potential, making the purchase of a home computer more affordable compared to those in blue-collar types of employment, which may explain these results.

Results from the BDI were a mean of 11.2 (SD 13.9), indicating mild to moderate levels of depression compared to normative data. Prior research showed that analysis of the ZDI provided a mean of 38.56 (SD = 10.24), also indicating mild to moderate levels of depression when compared to normal populations.~ Therefore, the BDI yielded similar results as the prior work suggesting that depression is a significant factor in the development of PIU.

DEPRESSION AND INTERNET ADDICTION DISCUSSION

As noted with other addictive disorders, our findings suggest that increased levels of depression are associated with those who become addicted to the Internet. This suggests that clinical depression is significantly associated with increased levels of personal Internet use. These results should be interpreted with caution, however, as self-selected sample biases exist in this study coupled with the questionable accuracy of on-line responses.

This study suggests that accurate assessment of depression and PIU can improve early detection, especially when one is masked by primary symptoms of the other diagnosis. It is likely that low self-esteem, poor motivation, fear of rejection, and the need for approval associated with depressives contribute to increased Internet use, as prior research indicated that the interactive capabilities available on the Internet were found to be most addictive.² It is plausible that depressives are drawn to electronic communication because of the anonymous cover granted to them by talking with others through fictitious handles, which helps them overcome real-life interpersonal difficulties. Kiesler et al.¹⁴ found that computer-mediated communication weakens social influence by the absence of such nonverbal behavior as talking in the head set, speaking loudly, staring, touching, and gesturing. Therefore, the disappearance of facial expression, voice inflection, and eye contact makes electronic communication less threatening, thereby helping the depressive to overcome the initial awkwardness and intimidation in meeting and speaking with others. This anonymous two-way talk also helps depressives feel comfortable sharing ideas with others thanks to the personal control over the level of their communication, as they have time to plan, contemplate, and edit comments before sending an electronic message. Therefore, the treatment protocol should emphasize the primary psychiatric condition, if related to a subsequent impulse control problem, as addictive Internet use. Effective management of such psychiatric symptoms may indirectly correct PIU.

Based on the findings, it is concluded that evaluation of suspected cases of PIU should in-dude assessment for depression. These results, however, do not clearly indicate whether depression preceded the development of such Internet abuse or if it was a consequence. Young² showed that withdrawal from significant real-life relationships is a consequence of PIU. Therefore, the possibility exists that increased levels of social isolation subsequent to excessive time spent in front of a computer may result in increased depression rather than be a cause of such Internet overuse. Therefore, further experimentation with a more comprehensive level of analysis is necessary to examine cause and effect. Data collection should also include patients in treatment to eliminate the methodological limitations of an on-line survey and to improve the clinical utility of the information gathered. Finally, although it is unclear how PIU compares to other established addictions, future research should investigate if clinical depression is an etiologic factor in the development of any addictive syndrome, be it alcohol, gambling, or the Internet.

next:Researchers Find Sad, Lonely World in Cyberspace
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REFERENCES

1. Young, K.S. (1997, April 11). Leoels of depression and addiction underlying pathological Internet use. Poster presented at the annual meeting of the Eastern Psychological Association, Washington, DC.

2. Young, K.S. (1996, August 10). Internet addiction: The emergence of a new clinical disorder. Paper presented at the 104th annual meeting of the American Psycho-logical Association, Toronto.

3. Capuzzi, D., & Lecoq, L.L. (1983). Social and personal determination of adolescent use and abuse of alcohol and marijuana. Personnel and Guidance Journal, 62, 199-205.

4. Cox, W.M. (1985). Personality correlates of substance abuse. In M. Galizio & S.A. Maisto (Eds.), Determinants of substance abuse: Biological, psychological, and environmental factors (pp.209-246). New York: Plenum.

5. Lacey, H.J. (1993). Self-damaging and addictive behavior in bulimia nervosa: A catchment area study. British Journal of Psychiatry, 163, 190-194.

6. Lesieur, H.R., & Blume, S.B. ~993). Pathological gambling, eating disorders, and the psychoactive substance use disorders. Journal of Addictive Diseases, 12(3), 89-102.

7. Blaszczynski, A., McConaghy, N., & Frankova, A. (1991). Sensation seeking and pathological gambling. British Journal of Addiction, 81, 113-117.

8. Criffiths, M. (1990). The cognitive psychology of gambling. Journal of Gambling Studies, 6, 31~2.

9. Mobilia, P. (1993). Gambling as a rational addiction. Journal of Gambling Studies, 9(2), 121-151.

10. Zung, W.K. (1965). Self-rating depression scale. New York; Springer-Verlag.

11. Beck, A.T., Ward, C.M., Mendeleson, M., Mock, J.F., & Erbaugh, J.K. (1961). An inventory for measuring depression. Archives of General Psychiatry, 4, 5~-571.

12. American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.

13. Zuckerman, M. (1979). Sensation seeking behavior: Beyond the optimal level of arousal. Hillsdale, NJ: Erlbaum.

14. Kiesler, S., Siegal, I., & McGuire, T.W. (1984). Social psychological aspects of computer-mediated communication. American Psychologist, 39(10), 1123~134.

15. Cattell, R. (1975). Sixteen Personality Factor Inventory. The Institute of Personality and Ability, Inc., Champaign, IL

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Are you a black person in a blue funk that just won't go away?

Do the things that once gave you pleasure now seem uninspiring, and are you sleeping and eating a lot more or a lot less than is normal for you? If the answer to these questions is "Yes," you may be depressed. But you are not alone. About 17 million people a year suffer from depression, mental health experts say.

And if you are an average black person in America, you are more likely than an average white person to suffer depression.

You don't have to remain depressed, however. Dr. Freda Lewis-Hall, a psychiatrist who has worked extensively in the African-American community says not nearly enough blacks who are depressed seek professional help. "Most either believe that depression, or the "blues," is a necessary condition of life and must be endured, or they fear being labeled as insane and therefore do no seek professional help," says Dr. Lewis-Hall.

In addition to dramatic changes in sleeping and eating patterns, Dr. Lewis-Hall says symptoms of clinical depression include "changes in energy level, so that there is a lack of energy; not enjoying things that were previously enjoyed, like you've gone to church every Sunday, but for weeks you can't get up and go to church. You just feel so depressed."

A survey by the National Mental Health Association revealed that only one-third of all persons with major depression ever seek treatment. According to the study, African-Americans and persons over 65 years old are the least likely to seek professional help for depression.

Dr. Lewis-Hall, who is a clinical research physician at U.S. Medical Operations and is director of the Women's Health Center at Eli Lilly and Company, stresses that most depression cases are treatable. "In fact, more than 80% of people with clinical depression can successfully recover and resume normal, happy and productive lives," Dr. Lewis-Hall stated in a paper on clinical depression in the African-American community.

Dr. Lewis-Hall said the medical community could not say in every case precisely what caused depression but had identified certain factors that could either cause depression directly or predispose a person to be depressed.

"What we believe is that, number one...depression seems to run in families, and so we know that there is some predisposition, some genetic piece to it," she said. "The other piece of it is what happens in the environment. And there are certain things that we recognize as risk factors for the development of depression, and they include things like having been a victim of abuse, or violence, poverty, chronic or serious illnesses - cancer, heart disease, diabetes. We think that people with chronic illnesses have systems that are likely to develop other illness, that there is an actual change in the physiology of the person that actually leads to the development of depression."

Dr. Lewis-Hall adds that not everybody that gets diabetes also gets depression. Not everybody that's hospitalized for very serious illness gets clinical depression. "One would think that if you went into a population of people with cancer everybody would have depression, because having cancer is a depressing thing. But the reality is that only (20-35%) percent of them actually go on to develop this medical illness that we call depression. They may be sad at some point after hearing the diagnosis or after going through the treatment, but to actually develop (depression), not everybody does it."

Nonetheless, the 20-35% percent rate of depression among persons with serious or chronic illness is likely to account for a larger portion of the black population than the white population, since African-Americans suffer conditions such as high blood pressure, heart disease, diabetes and lupus at a significantly higher rate than whites.

Additionally, some mental health experts believe that the stresses of racism and the attendant social undervaluing of the victims of racism lead to low self-esteem among those persons. Therefore, the stress of encountering racism and the low self-esteem caused by it are thought to be contributors to depression in some African-Americans, Dr. Lewis-Hall said.

To improve their chances of overcoming depression, African-Americans who are afflicted- and their friends and families - need to recognize the cultural norms and myths in the African-American community that contribute to depression and the tendency to live with it untreated, Dr. Lewis-Hall said. And sufferers need to seek professional help for their depression, she said.

Citing her own experience as an African-American and a mental health expert diagnosing and treating depression in African-Americans during an Urban Corps assignment in Washington, D.C., Dr. Lewis-Hall said "the stigma continues to be great." The relative isolation of African-Americans from the U.S. information mainstream has prevented them from being full beneficiaries of the aggressive public education campaign on depression that has been carried on in the media in recent years, Dr. Lewis-Hall said.

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That campaign has helped white Americans and many other non-African members of U.S. society to improve their attitudes and approaches to depression, while African-Americans mostly have been left behind, still clinging to unhealthy beliefs about depression and the stigma of insanity.

"We don't often have an opportunity to hear depression described as the medical illness that it is," she said. "If we look at the exposure of African-Americans to things that we recognize as risk factors in developing depression, (we see that) we get exposed to those more often. What we don't think is that there is a genetic predisposition on the part of African-Americans to be depressed."

Significantly, the risk factors that predispose many African-Americans to depression frequently affect another visible group of persons in the U.S. - immigrants. Because immigrants tend to be poorer than the mainstream population, and because many of them also experience racism and are often undervalued as persons, they too experience high levels of depression.

Some immigrants feel isolation and hopelessness and slide progressively into depression under the weight of language barriers, cultural differences, poverty, racism and generally being undervalued.

"There have been number of studies that have been shown that immigrants to this country, and to other countries, are clearly at risk for the development of depression and other mental illnesses. That is because immigration is one of the toughest of all stressers," Dr. Lewis-Hall said.

The stress of immigration "includes loss of people that you love because you usually leave them behind. It changes your entire perspective. It changes everything. It changes where you live, where you work, who you socialize with. And as much as many cultures are pliable in accepting people who have immigrated there ... immigration still is an enormous stresser unto itself," she said.

next: How Do Hispanics Experience Depression?
~ depression library articles
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• Basics #1: Your Needs and Wants
• Basics #2: Your Natural Feelings
• Basics #3: Unnatural Feelings
• Clear Communication: #1
• Clear Communication: #2
• Guidelines For Emotional Health
• Success

 

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next: Who Needs Help?

Oncologist shares experiences of treating cancer patients and learns that cancer is a journey that also provides opportunities for healing and transformation.

As a medical oncologist, I have been honored to serve as physician, guide, and friend to thousands of individuals with cancer and their loved ones. Many heroic people have inspired and taught me a great deal about living courageously in the face of great challenges, and the unknown.

Through this process, I have come to understand the experience of cancer as a journey -- filled with ups and downs, periods of calm and tumult, and extraordinary opportunities for healing and transformation. I have also seen, again and again, what powerful roles the mind, heart, and spirit can play in impacting every individual's journey through cancer.

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It is normal and common to feel overwhelmed by a cancer diagnosis, as anyone who has been through this experience can attest. Unfortunately, it is not yet normal or common for individuals and families to receive skillful, coherent, and comprehensive help in navigating the mental, emotional, and spiritual aspects of cancer. For many, this is a painful and tragically missed opportunity. But it doesn't have to be so.

Over many years of running an integrative cancer center, I was repeatedly asked: "Doctor, in addition to radiation, chemotherapy, and surgery, what else can I do to help myself? What should I eat? What vitamins should I take? What alternative therapies should I use?" And, "How can I deal with the mental, emotional, and spiritual challenges I am encountering?"

In searching for meaningful and practical answers, I saw an important pattern. I recognized that all questions and concerns encountered by patients and their loved ones fall into one of seven distinct, but inter-related domains of inquiry and exploration. I call these The Seven Levels of Healing® and describe them in detail in The Journey Through Cancer: Healing and Transforming the Whole Person. They are a powerful guide for navigating all aspects of the cancer journey, including the mental, emotional, and spiritual -- as well as physical -- ones.

The Seven Levels are briefly summarized below, along with some practical suggestions for using them right away:

Level One:Education and Information. Understanding your medical care is important to achieving the best outcome. Feeling clear and confident about your care helps put your mind at ease and enhances your ability to enter the deeper dimensions of healing. Find an experienced oncologist whom you trust, and who answers your questions fully. Don't make hasty decisions. Make decisions based on knowledge and understanding, not on fear.

Level Two:Connection with Others. This is a powerful component of healing. Family members can only do so much. Seek additional support from friends, clergy, and self-help organizations. Join a support group. Talk with others who have navigated the journey though cancer and found positive solutions.

Level Three:The Body as Garden. Conventional treatments remain the foundation of leading-edge cancer care. However, taking an active role in caring for your body also includes good nutrition, exercise, massage, relaxation, and other complementary therapies. These can nourish and strengthen the body, soothe and calm the mind, and invigorate the heart and spirit.

Level Four: Emotional Healing. Cancer can be an emotional roller-coaster. Everyone involved can experience feelings of fear, anger, depression, and doubt -- as well as gratitude and love. Keep a journal to explore and release your innermost feelings. Work with a counselor or therapist. Don't neglect your emotional self.

Level Five: The Nature of Mind. Mental anxiety is often another part of cancer. The mind can work for or against you, depending on your focus. To avoid feeling overwhelmed, examine your thoughts and beliefs and see if they are serving you. When fear and doubt are replaced with clarity and understanding, anxiety often diminishes. Ask yourself, "What are the blessings in my life? What am I truly grateful for?"

Level Six: Life Assessment. It is very empowering to discover the deepest meaning and purpose of your life, especially in the face of cancer. Answering three important questions can help clarify your priorities and liberate enormous time, energy, and resources for healing:

• What is the meaning and purpose of my life?
• What are my most important goals for the coming year?
• How do I want to be remembered by those whom I love?

Level Seven: The Nature of Spirit. There is no better time than now to fully honor and embrace your spiritual essence. It is the source not only of the love, joy, and fulfillment that we all seek, but physical healing as well. Explore this through meditation, reflection, prayer, time in nature, and sharing with loved ones. Remember that your body needs love and care, but your mind, heart, and spirit need and deserve these as well.

Copyright © 2006 Jeremy R. Geffen

Jeremy R. Geffen, MD, FACP, is a board-certified medical oncologist, a Fellow of the American College of Physicians, and a renowned pioneer in integrative medicine and oncology. He is founder of Geffen Visions International (www.geffenvisions.com) and Director of Integrative Oncology for P4 Healthcare and Caring4Cancer.com. He is also author of the highly acclaimed book The Journey Through Cancer: Healing and Transforming the Whole Person (Three River Press, 2006) and audio program The Seven Levels of Healing®.

In 1994, he founded the Geffen Cancer Center and Research Institute in Vero Beach, FL, which he directed until 2003. It was one of the first cancer centers in the United States explicitly designed to provide a working model of truly holistic, comprehensive cancer care for the twenty-first century. Dr. Geffen lectures widely and offers seminars and retreats on the multidimensional aspects of medicine, wellness, and life. He also advises organizations on integrative programs for medicine and healing.

next: Articles: Kenosha

• About Change
• About Shame
• Clients and Success in Therapy
• Depression: What To Do About It
• Discipline
• False Memories and Responsibility
• Feeling Like You Belong
• Getting Enough Attention
• Growing Up Emotionally
• Handling Criticism
• Healing From Sexual Abuse: A Strategy
• How Does Abuse Happen?
• How To Have A Lousy Sex Life
• How To Talk About Feelings
• Life's Craziest Beliefs
• Living With Alcoholics
• Loneliness
• Natural Anger
• Perfectionism
• Personal Freedom
• Problems With Anger
• Quitting Addictions
• Sexual Abuse In Childhood
• Shame: What You Can Do About It
• Subconscious Life Scripts
• Were You Loved As A Child?
• What To Tell A Therapist
• Who Is The Real You?
• Who's Healthy?

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next: I Often Feel Futile or Hopeless.

Be My V-A-L-E-N-T-I-N-E All Year Long - Valuable words from the letters in the word Valentine that will help you remember to be your best to make it Valentine's Day in your relationship. . . all year long.

For YOUR Eyes Only - Have you ever sat down, discouraged and out of steam, stuck and with a sense of hopelessness about your relationship? Have you ever felt like you needed to express what you felt? Have you ever taken the opportunity to write some notes to yourself about how you are feeling, even the feelings you feel uncomfortable sharing with anyone? Some call it "journaling." Here are some guidelines to help you begin answering these important questions.

Maturity In Relationships - Maturity in a love relationship is everything! First it is the ability to base a decision about a love relationship on the big picture - the long haul. In general, it means being able to pass up the fun for the moment and select the course of action which will pay off later. Maturity is this and a lot more.

Friends & Lovers - Your love partner should be your best friend and lover. At the heart of love, there is a simple secret: the lover lets the beloved be free. The stronger and more secure they become, the more they are willing to be themselves while encouraging their love partner to do the same. Genuine unconditional love not only respects the individuality of the other but actually seeks to cultivate it. Mostly written in an affirmative voice.

15 Hot Ideas for Phenomenal Physical Intimacy! - Need we say more?

Making Love - Thoughts and reflections on making love. Tastefully expressed. The experience of physical intimacy can be the single most loving, most exciting, most powerful, most exhilarating, most renewing, most energizing, most affirming, most intimate, most uniting, most stress- relieving, most recreative physical experience of which humans are capable.

Forgiveness. . . What's it for? - Forgiveness is often misunderstood. We often think of forgiveness as something that someone who has done us wrong must ask of US. This article suggests that you focus on offering forgiveness TO the person who has wronged you as a healthy way of releasing the anger, resentment, etc. This was the topic of Larry James' appearance on ABC TV's "The View with Barbara Walters and her co-hosts.

Same Event! Different Scores! If We're in This Together Why Aren't We On the Same Team? - Men and women see and hear things differently! Perhaps it's all about interpretation! Could it be true that we all experience contrasting realities of the same event? Do we all think we are right? Are we committed to hold on to that opinion? Does this make us happy in our relationships?

Shadows of the Past - Shadows of the past are our out-dated precepts and ideas that serve no one. They are our preconceived notions about how we think things should be, should turn out or how things are. The past is an energy drain. Larry tells you how to let go.

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Weigh Your Words - You cannot un-ring a bell! It is a wise love partner who is aware of the potential damage loose words can cause. Words spoken in anger inflict wounds that often take a long time to heal. Think first. . . then speak!

I Married My Best Friend's Wife! - This is the true story of how Larry James met his wife, Sandy. If the title tweaked your curiosity and you like happy endings, you will love this story.

A Prayer of Thanksgiving! - This article focuses on being grateful for ALL our relationships.

How to Get the Most From Reading a Relationship Book - Follow these tips and watch your relationship prosper.

. . . And if All Else Fails? - REQUIRED READING if you are considering counseling, therapy (or Personal Relationship Coaching by telephone with Larry James). There is no shame in seeking help from someone qualified to give it. Most people resist change until they are backed against the wall; until they feel that there is nothing else they can do. Change takes courage! It means taking responsibility for your relationship and being brave enough to take that first step toward doing something different while you are still afraid.

LoveNote for Singles Only - Some singles have concerns that life is passing them by. They wonder why you haven't found their true love. They need to learn to trust their heart! It always tells the truth! Larry offers suggestions that can relieve the stress and worry of being alone and being lonely.

The 3 BIGGEST Mistakes Newly Singles Make and How to Avoid Them - "For Singles" - The BIGGEST mistakes that newly singles can make are mistakes that most singles refuse to believe and, as a result, they soon find themselves experiencing the same relationships as in the past. It is an even bigger mistake to not acknowledge that these colossal blunders really ARE mistakes! Evade these avoidable errors in judgment, and ALL of your relationships will work better!

Who Would You Have to Become? - "For Singles" - Who would you have to become to have your relationships be great? What could you do differently? Whose assistance could you request? How will you change? Or will you? Are you willing to stop trying to change your love partner? Suggested strategies worthy of pursuit.

Learning to Love the One You're With - "For Singles" - Spend time working on you. Work on developing your own self as an individual. The one you are with is you! Reinvent a relationship with yourself. Make it a new and exciting relationship; one you can be proud to carry over into your next relationship with someone else.

Putting Your Best Foot Forward OR Should I Be Who I Really Am on the First Date? - "For Single Men" - We must create a future worth living into. The old way of being in a relationship isn't good enough in the '90's. We must invent the kind of relationship we want, then go about devoting our time and energy to making it happen. It will happen when we care enough to give ourselves the very best of everything.

New Beginnings! What to Do? - Alone again? Perhaps it's time to invent a new beginning. You can do that most effectively by working on you; preparing for love. There is no shame in starting over. How do you work on YOU? You begin by paying attention to what you need to be fulfilled as an individual. Focus on YOU! Self inquire!

Powerful Beyond Measure: What's This About Mid-life Crisis? - Is mid-life crisis a myth? We all have decisive and critical moments from time to time. A crisis or two now and then perhaps, but a crisis that ongoingly occupies an important part of our mid-life? Certainly we have learned by now that crises take our attention off of living life to its fullest. . . moment by moment.

The 10 "Commitments" of Networking - Networking is about building supportive, personal and business relationships; it's consistently meeting new people and making new friends, sharing ideas and having lots of fun in the process! Larry briefly reviews the 10 things you must be committed to if you intend to have networking be an effective business relationships tool.

Networkings' Top Ten "Hot Ideas!" - What does networking have to do with relationships? Networking is all about developing great relationships; meeting new people, making new friends, business contacts and finding new prospects. This article presents 10 "Hot Ideas" that will help put your business networking activities on fast forward!

The Secret to Solving ALL Your Problems! - What's the secret? You are the voice! What you say goes. You are in charge here. Think and speak only of what you want. Your past is before you. It is created individually by you today. You alone have the choice to make it one you can live with!

Rx for the "Holiday Blues" - Here is a healthy prescription of 16 ways to help you overcome the "Holiday Blues."

A Strawberry Malt and 3 Squeezes, Please! - This story was originally featured in the New York Times Best Selling book, "A 2nd Helping of Chicken Soup for the Soul" by Mark Victor Hansen & Jack Canfield. It is a heart-warming story of love, written to honor the memory of Larry's mother, Mary N. Jarvis. She died as a result of Alzheimer's disease. Also see: Alzheimer's Links.

Is Your Relationship Stranded at Malfunction Junction? - Having a successful relationship is like driving a car at night. You can only see as far as your headlights shine up ahead, AND you can make the entire trip that way. When you see a bump in the road or have to take a detour (to avoid a major disagreement), you simply make a mutually beneficial adjustment and keep on going!

Half of Being Smart is Knowing What You're Dumb At! - Here's something to think about. . . I've been wondering what it is that causes someone to treat their friends much better than the one they say they love?

I Was Wrong and I Am Sorry - As a professional relationship coach, over the years I have listened as partners pour out their hearts to me, justifying their position to the detriment of the relationship.

Are You Being Authentic in Your Relationship? - Being authentic is the key to truly happy, healthy relationships. It is not possible to be happy without being true to yourself. Unfortunately many people live their entire lives never discovering their authentic self.

Hey Guys! Don't be Someone Who Grumbles! - If you want to keep your significant other happy and content. . . (read on)

What's to Become of You? - "What's to become of me?" you say? That may be the wrong question. What "more" is to become of me? Ask yourself that question and see what comes up.

The Truth About Relationship Expectations - Having expectations in our culture is expected. We are brought up that way. Having great expectations sounds great however when the expectation is unfulfilled, we bitch, we moan, we become disappointed.

What to Do? What to Do? - Thoughts on the Dilemma of Choice! - Dissatisfied with the direction your life is going; the work you do, the relationship your are in? Wondering what to do? Perhaps it's time to do something different. Here are some thoughts about the dilemma of making the choices to change.

Romantic Jealousy is Scary! - Jealously. . . it feeds on your insecurity, devours your self-confidence, and gobbles up the trust in your relationship. Believe it or not, like other difficult emotional experiences, jealousy can be a trigger for growth, increased self-awareness, and greater understanding of both your partner and your relationship.

Kidding Around With Romance - Youthful and playful activities can add spark to your relationship. Being playful in adult relationships is a good thing. It's perfect for a first date and can even help light a fire under long-term couples whose affections have cooled.

Romantic Ideas to Make it Valentine's Day All Year Long! - To be a special Valentine to your partner takes lots of energy, time, attention and Love. Here are more than 67 tips to help you get started!

A Gift of the Heart - Want to know how to avoid a gift-giving blunder? To help you develop gift-giving savvy, when you give a gift during the holiday season or on any other occasion, make it a gift of the heart.

The Romantic Kiss - A kiss has been described as the height of voluptuousness. It has a lovely, luscious and lusty legacy.

Jazz Up Your Relationship - A few thoughts about how jazz music can teach you an important relationship lesson.

Communicating is Not Optional: How to Listen So Your Partner Will Talk - A communication gap not only undermines the potential of your relationship; it can, and usually will eventually destroy the relationship. Use an effective process Larry James uses when coaching couples to teach them to listen and talk, but not at the same time.

What Is Love? - Random thoughts and reflections on Love.

The ABC's of Celebrating Love! - You didn't learn this alphabet in school. 26 words that can help breathe life into your relationship and help you Celebrate Love with your partner; words that begin with each letter of the alphabet.

My Partner Cheat? Never! - Twenty-nine red flags that often point a finger to a cheater.

Poems by Larry James - Two poems based upon a real relationship cast in an imaginary setting. See You At the Beach will give you a sense of the beginning.

Release Your Brakes! - This inspirational poem was inspired by James W. Newman's original classic book by the same name.

Relationship "Slump Busters" - A list of 52 areas in relationships that can become "Hot Spots" unless they are attended to on a consistent basis; areas that will need your undivided attention if you are committed to work "together" to bring your relationship out of a slump or to keep it from going into one. You will want to bookmark this article and read it often. It is "Larry's Rx for Relationships!"

How Do You Work On You? - Often therapists, radio talk show hosts and others who provide relationship advice or coaching will tell you that in order to have a great relationship with your partner, you must first work on you. This article tells you how to begin.

Men Have Feelings Too! - For Men Only - A discourse in support of a safe place to express your feelings. Scary stuff, huh? Plus complete guidelines for creating a "Men's Support Community." (They work for women too).

A Sure Cure for a Hangover - The facts on the abuse of alcohol are sobering. Alcohol consumption affects men and women differently, however some effects are the same in both genders. Plus Larry's hangover "sure cure!"

Networking: A Woman's Contact Sport - Do women network more effectively than men? Read the success stories of Larry's "Top Five" women networkers and about the personal growth you can expect when you set a priority on networking.

An Affirmation for Letting Go - Positive affirmations work if you are consistent in using them and if you are willing to suspend your disbelief. This affirmation will help you let go of the past and get on with your life!

Put the Toilet Seat DOWN! - For Men Only - It's time for men to be more "considerate" and to pay attention to the little things, like putting the toilet seat down and helping with the household chores. There is a solution to one of the problems. Inventor, Tim Seniuk's amusing solution may surprise you.

Goodbye, Cavett! - Cavett Robert, CSP, CPAE, was the founder of the National Speakers Association. This article was written to honor his memory.

Domestic Violence Sucks! - Physical and emotional abusive behavior is sick! If you are in an abusive relationship, this article is a must-read. Includes helpful info and links for support for abuse victims. - Read one women's story about physical abuse and Larry's recommendation for her situation.

Principles of Being - Austin Vickers, Guest Author - Allow this affirmative statement to govern your life. Book mark it and read it often. It will change your life.

Some Things Can Be Fixed. . . Others Must Heal - Thom Rutledge, Guest Author - When someone tells you a problem they are having, do you immediately feel the need to offer advice? Is it difficult for you to just listen to someone who is in distress, to just be there for them without knowing precisely what to say or do?

Have You Written a Love Letter Lately? - Michael J. Montegut, Ph.D., Guest Author - One of the most powerful and sincerest forms of communication that we see very little of today is letter writing. I am not talking about e-mail or post-its. I mean a real letter that is written on real paper and possibly mailed through the regular mail.

Questions, Questions and More Questions - For Singles Only - Are you asking the right questions? It is estimated that 83% of failed relationships could be prevented if couples asked each other the right questions. Are you among the 17%?

The Dating Daze! - For Singles Only - The grown-up dating game has never been more interesting and challenging. There are more players than ever before. Why? Because of higher divorce rates, longer life spans, and a greater tendency to never marry. This contributes to more single Americans than at any other time in our country's history.

25 Words or Less: Connecting With Personal Ads - For Singles Only - Read Larry's take on the personal responsibility you must accept when writing or answering personal ads.

NOTE: All articles listed above are available for reprint in magazines, periodicals, newsletters, newspapers, on the Internet or on your own website. Contact Larry James for conditions and permission to reprint.

Blog Comments

• No Expectations, Fewer Disappointments!
• Is Your Relationship Stranded at Malfunction Junction?
• The Keys to Self-Acceptance
• I Was Wrong and I Am Sorry
• Larry James Selected "Best Officiant" in the Greater Phoenix Area!
• Building Better Business Relationships
• New Things are Happening!
• Who YOU are Being Makes a Difference!
• Getting Your Needs Met MUST Be a HIGH Priority
• Me Change? Yuk!!
• Relationships Require Attention
• 10 Ways to Simplify Your Life
• I Hate Snakes!
• There is no Second Place!
• Random Thoughts to a Coaching Client
• No One Can Hurt You
• Forgiveness
• Never Intentionally Say Hurtful Words to Your Partner
• Audioapathy
• Do What Works!
• The Essence of Romance
• It's Time for the 3rd Degree!
• Catch Your Partner Doing Something Right!
• Relationships NEVER End!
• Unfulfilled Expectations
• Relationship Derailment

next: Be My V-A-L-E-N-T-I-N-E All Year Long

Child: Care, Health and Development,
November 2002, vol. 28, no. 6, pp. 523-527(5)

Steyn B.J.[1]; Schneider J.[2]; McArdle P.[3]

[1] Child and Adolescent Psychiatry, Mulberry Centre, Darlington, [2] Centre for Applied Social Studies, University of Durham, Old Shire Hall, Old Elvet, Durham, and [3] University of Newcastle, Fleming Nuffield Unit, Newcastle, UK

Abstract:

Objective To explore the use of Disability Living Allowance (DLA) by families of children and adolescents with Attention-Deficit/Hyperactivity Disorder (ADHD), and to discuss the implications for clinicians involved in their treatment.

Study design Opportunistic survey of patients attending ADHD clinic.

Setting Urban area in the north-east of England.

Subjects A total of 32 carers of children being treated for ADHD with methylphenidate.

Intervention Semi-structured telephone interviews about receipt and use of DLA. This involved open and closed questions and a multiple-choice section.

Results In total, 19 out of the 32 families were receiving DLA. They chose to use it mainly to replace clothes and furniture and to provide diversions and activities for the children concerned. Some families were unaware of potential eligibility for DLA, whereas a few had chosen not to apply. Only one family's application for DLA had been unsuccessful. Carers were unanimously positive about the extra income.

Conclusions Families view DLA as an important means to replace damaged items and to fund recreational activities to contain over-activity. Families receive little formal guidance on ways of using DLA money to support children with ADHD. Virtually no specific training in benefits awareness is provided to general practitioners and child health specialists, who are often asked to judge the child's level of impairment or incapacity. Applying for DLA may affect the therapeutic relationship for good or ill. There is a need for professionals in contact with children with ADHD to inform families of the possibility of receiving DLA and support them in applications. As diagnosis and treatment of ADHD becomes more commonplace, more families are likely to be entitled to claim DLA. This has definite implications for the social security budget.

Keywords: ADHD; DLA; disability; benefits; social security; treatment

Document Type: Research article ISSN: 0305-1862

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DOI (article): 10.1046/j.1365-2214.2002.00305.x
SICI (online): 0305-1862(20021101)28:6L.523;1-

Here's how Alcoholics Anonymous came to be a primary treatment of alcoholism.

In this section:

• Big Book (Alcoholics Anonymous), The Doctor's Opinion
• Bill's Story
• There is a Solution
• More About Alcoholism
• We Agnostics
• How It Works
• Into Action
• Working with Others
• To the Wives
• The Family Afterward
• To Employers
• A Vision For You

The Doctor's Opinion

We of Alcoholics Anonymous believe that the reader will be interested in the medical estimate of the plan of recovery described in this book. Convincing testimony must surely come from medical men who have had experience with the sufferings of our members and have witnessed our return to health. A well known doctor, chief physician at a nationally prominent hospital specializing in alcoholic and drug addiction, gave Alcoholics Anonymous this letter:

To whom it may concern:

I have specialized in the treatment of alcoholism for many years. In late 1934, I attended a patient who, though he had been a competent businessman of good earning capacity, was an alcoholic of a type I had come to regard as hopeless.

In the course of his third treatment, he acquired certain ideas concerning a possible means of recovery. As part of his rehabilitation, he commenced to present his conceptions to other alcoholics, impressing upon them that they must do likewise with still others. This has become the basis of a rapidly growing fellowship of these men and their families. This man and over one hundred others appear to have recovered.

I personally know scores of cases who were of the type with whom other methods had failed completely.

These facts appear to be of extreme medical importance; because of the extraordinary possibilities of rapid growth inherent in this group they may mark a new epoch in the annals of alcoholism. These men may well have a remedy for thousands of such situations.

You may rely absolutely on anything they say about themselves.

Very truly yours,

William D. Silkworth, M.D.

The physician who, at our request, gave us this letter, has been kind enough to enlarge upon his views in another statement which follows. In this statement, he confirms what we who have suffered alcoholic torture must believe that the body of the alcoholic is quite as abnormal as his mind. It did not satisfy us to be told that we could not control our drinking just because we were maladjusted to life, that we were in full flight from reality, or were outright mental defectives. These things were true to some extent, in fact, to a considerable extent with some of us. But we are sure that our bodies were sickened as well. In our belief, any picture of the alcoholic which leaves out this physical factor is incomplete.

The doctors theory that we have an allergy to alcohol interests us. As laymen, our opinion as to its soundness may, of course, mean little. But as ex-problem drinkers, we can say that his explanation makes good sense. It explains many things for which we cannot otherwise account.

Though we work out our solution on the spiritual as well as an altruistic plane, we favor hospitalization for the alcoholic who is very jittery or befogged. More often than not, it is imperative that a mans brain be cleared before he is approached, as he has then a better chance of understanding and accepting what we have to offer.

The doctor writes:

The subject presented in this book seems to me to be of paramount importance to those afflicted with alcoholic addiction.

I say this after many years experience as a Medical Director of one of the oldest hospitals in the country treating alcoholic and drug addiction.

There was, therefore, a sense of real satisfaction when I was asked to contribute a few words on a subject which is covered in such masterly detail in these pages.

We doctors have realized for a long time that some form of moral psychology was of urgent importance to alcoholics, but its application presented difficulties beyond our conception. What with our ultramodern standards, our scientific approach to everything, we are perhaps not well equipped to apply the powers of good that lie outside our synthetic knowledge.

Many years ago, one of the leading contributors to this book came under our care in this hospital and while here he acquired some ideas which he put into practical application at once.

Later, he requested the privilege of being allowed to tell his story to other patients here and with some misgiving, we consented. The cases we have followed through have been most interesting; in fact, many of them are amazing. The unselfishness of these men as we have come to know them, the entire absence of profit motive, and their community spirit, is indeed inspiring to one who has labored long and wearily in this alcoholic field. They believe in themselves, and still more in the Power which pulls chronic alcoholics back from the gates of death.

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Of course an alcoholic ought to be freed from his physical craving for liquor, and this often requires a definite hospital procedure before psychological measures can be of maximum benefit. We believe, and so suggested a few years ago, that the action of alcohol on these chronic alcoholics is a manifestation of an allergy; that the phenomenon of craving is limited to this class and never occurs in the average temperate drinker. These allergic types can never safely use alcohol in any form at all; and once having lost their self-confidence, their reliance upon things human, their problems pile up on them and become astonishingly difficult to solve.

Frothy emotional appeal seldom suffices. The message which can interest and hold these alcoholic people must have depth and weight. In nearly all cases, their ideals must be grounded in a power greater than themselves, if they are to recreate their lives.

If any feel that as psychiatrists directing a hospital for alcoholics we appear somewhat sentimental, let them stand with us a while on the firing line, see the tragedies, the despairing wives, the little children; let the solving of these problems become a part of their daily work, and even of their sleeping moments, and the most cynical will not wonder that we have accepted and encouraged this movement. We feel, after many years of experience, that we have found nothing which has contributed more to the rehabilitation of these men than the altruistic movement now growing up among them.

Men and women drink essentially because they like the effect produced by alcohol. The sensation is so elusive that, while they admit it is injurious, they cannot after a time differentiate the true from the false. To them, their alcoholic life seems the only normal one. They are restless, irritable and discontented, unless they can again experience the sense of ease and comfort which comes at once by taking a few drinks which they see others taking with impunity. After they have succumbed to the desire again, as so many do, and the phenomenon of craving develops, they pass through the well known stages of a spree, emerging remorseful, with a firm resolution not to drink again. This is repeated over and over, and unless this person can experience an entire psychic change there is very little hope of his recovery.

On the other hand and strange as this may seem to those who do not understand once a psychic change has occurred, the very same person who seemed doomed who had so many problems he despaired of ever solving them, suddenly finds himself easily able to control his desire for alcohol, the only effort necessary being that required to follow a few simple rules.

Men have cried out to me in sincere and despairing appeal: "Doctor, I cannot go on like this! I have everything to live for! I must stop, but I cannot! You must help me!"

Faced with this problem, if a doctor is honest with himself, he must sometimes feel his own inadequacy. Although he gives all that is in him it often is not enough. One feels that something more than human power is needed to produce the essential psychic change. Though the aggregate of recoveries resulting from psychiatric effort is considerable, we physicians must admit we have made little impression upon the problem as a whole. Many types do not respond to the ordinary psychological approach.

I do not hold with those who believe that alcoholism us entirely a problem of mental control. I have had many men who had, for example, worked a period of months on some problem or business deal which was to be settled on a certain date, favorably to them. They took a drink a day or so prior to the date, and then the phenomenon of craving at once became so paramount to all other interests so that the important appointment was not met. These men were not drinking to escape; they were drinking to overcome a craving beyond their mental control.

There are many situations which arise out of the phenomenon of craving which cause men to make the supreme sacrifice rather than continue to fight.

The classification of alcoholics seems most difficult, and in much detail is outside the scope of this book. There are, of course, the psychopaths who are emotionally unstable. We are all familiar with this type. They are always "going on the wagon for keeps." They are over remorseful and make many resolutions, but never a decision.

There is the type of man who is unwilling to admit that he cannot take a drink. He plans various ways of drinking. He changes his brand or his environment. There is the type who always believes that after being entirely free from alcohol for a period of time, he can take a drink without danger. There is the manic depressive type, who is s, perhaps the least understood by his friends, and about whom a whole chapter could be written.

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There are types entirely normal in every aspect except in the effect alcohol has on them. They are often able, intelligent, friendly people.

All these, and many more, have one symptom in common: They cannot start drinking without developing the phenomenon of craving. This phenomenon, as we have suggested, may be the manifestation of an allergy which differentiates these people and sets them apart as a distinct entity. It has never been, by any treatment with which we are familiar, permanently eradicated. The only relief we have to suggest is entire abstinence.

This immediately precipitates us into a seething caldron of debate. Much has been written pro and con, but among physicians, the general opinion seems to be that most chronic alcoholics are doomed.

What is the solution? Perhaps I can best answer this by relating one of my experiences.

About one year prior to this experience a man was brought in to be treated for chronic alcoholism. He had but partially recovered from a gastric hemorrhage and seemed to be a case of pathological mental deterioration. He had lost everything worthwhile in life and was only living, one might say, to drink. He frankly admitted and believed that for him there was no hope. Following the elimination of alcohol, there was found to be no permanent brain injury. He accepted the plan outlined in this book. One year later he called to see me, and I experienced a very strange sensation. I knew the man by name, and partly recognized his features, but there all resemblance ended. From a trembling, despairing, nervous wreak, had emerged a man brimming over with self reliance and contentment. I talked with him for some time, but was not able to bring myself to feel that I had known him before. To me he was a stranger, and so he left me. A long time has passed with no return to alcohol.

When I need a mental uplift, I often think of another case brought in by a physician prominent in New York. The patient had made his own diagnosis, and deciding his situation hopeless, had hidden in a deserted barn determined to die. He was rescued by a searching party, and, in desperate condition, brought to me. Following his physical rehabilitation, he had a talk with me in which he frankly stated he thought the treatment a waste of effort, unless I could assure him, which no one ever had, that in the future he would have the "will power" to resist the impulse to drink.

His alcoholic problem was so complex, and his depression so great, that we felt his only hope would be through what we then called "moral psychology" and we doubted if even that would have any effect.

However, He did become "sold" on the ideas contained in this book. He has not had a drink for a great many years. I see him now and then and he is as fine a specimen of manhood as one could wish to meet.

I earnestly advise every alcoholic to read this book through, and though perhaps he came to scoff, he may remain to pray.

William D. Silkworth, M.D.

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