Leslie Glass's Blog, page 346

How Sleep Affects Your Relationships

 

In a properly functioning body, sleep helps the brain process your emotions and memories from the day. You wake up well-rested with enough mental space to both create and log new memories and work through the experiences of your day.

Sleep deprivation, on the other hand, is like falling into an icy river: “The body shuts down circulation to the appendages and tries to keep the core warm. It goes into survival mode,” says W. Christopher Winter, a neurologist based in Charlottesville, VA and the author of The Sleep Solution. When you’re not sleeping well, “your brain’s ability to do things gets whittled down to: find food, urinate, get through the day,” he says.

That means superfluous activities—like conversations with your partner, social outings or remembering to pick up the dry cleaning—go out the window.

Which is why sleep is more paramount to your relationships than you think. “All of the things it takes to make a relationship work are probably completely decimated by lack of sleep,” says Winter.

Here are three ways sleep impacts relationships—and how to gain the energy to fight back.

Emotions Are Thrown Out Of Whack

Ever feel like you just want your partner to get to the point of the story already, or that you’re a little more anxious than usual after an all-nighter? You might just be a bit tired.

When you’re sleep-deprived, the part of your brain that ties emotions to memories—the amygdala—doesn’t function properly, Winter says. That could take form in the amygdala releasing more or less neurotransmitters, which Winter says could lead you to overreact or not notice someone else’s emotions, respectively. In fact, a 2013 study published in the journal Psychosomatic Medicine found that the amygdala activity to stressors in poor sleepers predicted symptoms of depression and perceived stress.

In short: When we’re deprived of sleep, we’re more likely to overreact to situations that normally wouldn’t rattle us. “This can lead to more conflict and less satisfying relationships,”says Jennifer L. Martin, a clinical psychologist and behavioral sleep medicine specialist at UCLA.

“If you have ever seen a 2-year-old who skipped a nap, you can see a version of how we all react to sleep deprivation in terms of our emotions,” says Martin. “Small problems seem bigger. Our reactions are amplified. Some studies show that people are more likely to feel sad, depressed, or anxious if they don’t sleep well or if they are sleep-deprived.”

Unfortunately, Martin says, this is compounded by the fact that we don’t usually notice this amplification of our emotional reactions.

The next time you find yourself easily irritated, anxious or abrupt, think about how your sleep was for the past few nights. The simple realization that you might be overreacting can help diffuse a situation, Winter says.

Another tip: save the serious conversations for a day when you are more rested. Winter says sleeping better make us less prone to risky behaviors. We make better decisions, tend to be more patient and have a greater ability to listen and concentrate when we’re well rested (all components of a healthy relationship), Winter says.

Lack Of Sleep Makes You Sick

Insufficient sleep can put you at a risk for health issues including diabetes, obesity, heart disease, and depression, according to the Centers for Disease Control and Prevention. But other issues stem from insufficient sleep, too—like the common cold, Martin says. And that’s yet another factor that could keep you from being out and about with your partner.

After all, if you’re home sick, your interest in spending time with anyone or anything besides your bed can plummet. “That can have a negative impact on relationships,” says Martin. Over time, missing out on dinners or events because you’re too tired or too sick can wear on a relationship, she says.

And while the common cold is, of course, a smaller scale example, research suggests that, for partners, being a caretaker can be stressful and, specifically for women, negatively impact mental health.

Different Sleep Patterns Can Cause Relationship Problems

If you’re in a relationship and work odd-hour shifts, making plans to see the people who matter to you can be a challenge. After all, it can be difficult to find the time for a cookout if you work evenings while your partner works 9 to 5.

“It’s a rare person who can really nail it regarding a relationship and working unusual hours,” Winter says.

That’s why he suggests sharing a Google Calendar with loved ones. It can help you not only plan ahead, but also remember the arrangements you’ve already made—especially since a lack of sleep can impact memory, Winter says.

But what should you do if your partner has the precarious schedule? Meeting in the middle—staying up a little later or asking a partner to wake a little earlier—can also help to secure more together time, she says.

And perhaps most important, respect his or her need for sleep. “For some reason, couples feel like they can ask their partner to miss out on sleep so they can spend time together,” says Martin. A better bet is to focus on spending quality time together when your partner is most alert. “A 30-minute conversation is likely more important for maintaining a healthy relationship than watching two hours of Netflix,” she says.

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Hookah Smoking Harmful After All

In direct contradiction to marketing efforts claiming that hookah (water pipe) smoking is less hazardous to health than cigarettes, a new UCLA study published in the American Journal of Cardiology found that just a half-hour of hookah smoking resulted in the development of cardiovascular risk factors similar to what has been seen with traditional cigarette smoking.

Researchers measured heart rate, blood pressure, arterial stiffness, blood nicotine and exhaled carbon monoxide levels in 48 healthy, young hookah smokers before and after 30 minutes of hookah smoking. The study showed that a single session of hookah smoking increased heart rate (by 16 beats per minute) and blood pressure; and significantly increased measures of arterial stiffness, a key risk factor in the development of cardiovascular conditions such as heart attack or stroke. The increase in arterial stiffness was comparable to data seen from cigarette smokers after smoking a cigarette.

“Our findings challenge the concept that fruit-flavored hookah tobacco smoking is a healthier tobacco alternative. It is not,” said Mary Rezk-Hanna, an assistant professor at the UCLA School of Nursing and lead author of the study.

This study is believed to be the first to investigate the effects of hookah smoking on stiffening of the arteries. Studies have shown that as cigarette use continues to decline, hookah smoking is rising, especially among youth and particularly among college students.

“We know that flavored tobacco products are frequently the first kind of tobacco product used by youth,” Rezk-Hanna said. “One of the major issues with hookah is the fact that the tobacco is flavored with fruit, candy and alcohol flavors, making hookah the most popular flavored tobacco product among this audience.”

According to the Food and Drug Administration, under authority granted by the Family Smoking Prevention and Tobacco Control Act, cigarettes cannot contain an artificial or natural flavor (other than tobacco or menthol) or an herb or spice that is a characterizing flavor. But this prohibition does not apply to hookah, contributing to its rapidly growing popularity.

There are more than 2,000 shops in California that sell hookah tobacco and related products, in addition to 175 hookah lounges and cafes. A disproportionate number of these facilities are in Los Angeles, near universities and colleges. National data show that among adults ages 18 to24, 18.2 percent report hookah use, compared to 19.6 percent who use cigarettes and 8.9 percent who use e-cigarettes.

Results of the study are particularly concerning because it measured what appears to be the lower limit of hookah use (half an hour). Typically, a hookah session can last for several hours, potentially increasing the levels of nicotine and other toxins being absorbed in the body.

Stiffening of arteries and the aorta are important signs of progression of hypertension, which raises the risk of heart attacks, stroke and other cardiovascular disorders. Previous studies have shown that cigarettes, smokeless tobacco, cigars and most recently e-cigarettes produce similar rates of arterial stiffening seen in this hookah use study.

However, hookah smoking remains more popular, due to marketing efforts as well as social trends. In previous UCLA studies by Rezk-Hanna, when participants were asked why hookah smoking was more attractive than cigarette smoking, 48 percent of them replied that it was because of the fruity flavors and smells.

Originally published by Science Daily

Story Source:

Materials provided by University of California – Los Angeles Health Sciences. Original written by Andrew Porterfield. Note: Content may be edited for style and length.

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F.D.A. To Blame For Risky Fentanyl Prescriptions

From Emily Baumgaertner @ The New York Times: A fast-acting class of fentanyl drugs approved only for cancer patients with high opioid tolerance has been prescribed frequently to patients with back pain and migraines, putting them at high risk of accidental overdose and death, according to documents collected by the Food and Drug Administration.

The F.D.A. established a distribution oversight program in 2011 to curb inappropriate use of the dangerous medications, but entrusted enforcement to a group of pharmaceutical companies that make and sell the drugs.

Some of the companies have been sued for illegally promoting other uses for the medications and in one case even bribing doctors to prescribe higher doses.

About 5,000 pages of documents, obtained by researchers at Johns Hopkins University through the Freedom of Information Act and provided to The New York Times, show that the F.D.A. had data showing that so-called off-label prescribing was widespread. But officials did little to intervene.

“If any opioids were going to be tightly regulated, it would be these,” said Dr. Andrew Kolodny, an opioid policy researcher at Brandeis University, who was not involved in the investigation. Dr. Kolodny continues,

“They had the fox guarding the henhouse, people were getting hurt — and the F.D.A. sat by and watched this happen.”

Officials at the F.D.A. said they had reviewed evidence indicating that many patients without cancer were given the drugs. But they said that piecemeal data from various stakeholders — prescriber surveys, insurance claims and industry reports — made it difficult for the agency to measure potential harm to patients.

“The information we have isn’t very good, but it seems to indicate people who aren’t cancer patients are getting this and people who aren’t opioid tolerant are getting this,” Dr. Janet Woodcock, the director of the Center for Drug Evaluation and Research at the F.D.A., said in an interview.

“There has been a tremendous back-and-forth with companies on how to get better information.”

50 Times Stronger Than Heroin

The class of drugs — quick-absorbing fentanyl sprays, tablets and lozenges called T.I.R.F.s (for transmucosal immediate-release fentanyl) — contain a narcotic up to 50 times stronger than heroin and up to 100 times stronger than morphine. Examples include Actiq and Fentora, made by Cephalon, and Subsys, made by Insys Therapeutics.

The F.D.A. began approving the drugs outside of hospital settings in 1998 to treat cancer patients with “breakthrough” pain — sudden, sharp rushes of pain that overwhelm even a round-the-clock regimen of other opioids.

But for people taking the drugs, maintaining a round-the-clock regimen is vital: Without it, patients’ tolerance to them decreases, and they are at risk for accidental overdose, respiratory depression and death.

To restrict the dangerous drugs only to “opioid-tolerant” cancer patients, the F.D.A. in December 2011 established a safety program, called a risk evaluation and mitigation strategy, for a consortium of T.I.R.F. manufacturers.

The program required doctors to undergo training for prescribing T.I.R.F.s and to sign a form saying they understood that prescribing to other patients can be dangerous.

Drug Distributor Comes On Board

To administer the program, the consortium hired McKesson, a large national distributor that supplies drugs, including T.I.R.F.s, to pharmaceutical retailers.

In a statement, McKesson said it was doing its job as a third-party administrator of the program and noted that its requirements were “developed jointly by the manufacturers and the F.D.A. with ultimate approval resting with the F.D.A. McKesson administers the program according to these F.D.A. requirements.”

The safety program will be discussed in a meeting of an F.D.A. advisory committee on Friday, and the Johns Hopkins researchers will testify.

In a statement, Insys Therapeutics said it looked forward to the session and to “continuing to work with the F.D.A. to strengthen the program to ensure that only opioid-tolerant adult cancer patients with breakthrough cancer pain who are indicated for this special and highly regulated class of medications receive them.”

T.I.R.F. sales are lucrative: One prescription for a month’s worth can cost more than $30,000.

Dr. Woodcock said a stricter oversight program would be “extremely onerous” and that the harm caused by the drugs is difficult to measure, since “all drugs have risks and cause harm.”

With chronic back pain from two car accidents and a fibromyalgia diagnosis, Sarah Fuller, 31, needed pain medication.

She scheduled her medical appointment for a Monday in January 2015, a day her father took off from his job as a baker to accompany her. They met with a doctor — and, unexpectedly, a sales representative from Insys, maker of Subsys, an under-the-tongue narcotic spray.

“At no time were we told this drug was for terminally ill cancer patients,” said her mother, Deborah Fuller. “She had complete trust in doctors. I don’t know how they put their heads on their pillows at night.”

Ms. Fuller said her daughter had hoped that the medication would enable her to volunteer in nursing homes with her dog, Roxy. But 14 months later, Sarah’s fiancé found her dead in her bedroom.

The fentanyl in her blood was between 15 and 20 times the appropriate level, according to a toxicology report.

The F.D.A. documents obtained by researchers included a survey by the industry group in 2013 in which nearly 40 percent of T.I.R.F. prescribers said they had used the drug to treat chronic pain in patients who did not have cancer, like Ms. Fuller.

In the survey, 42 percent of pharmacists stated that the drugs were appropriate for those ailments.

In another survey three years later, in February 2017, almost one in five T.I.R.F. prescribers (18 percent) and almost one in two patients (48 percent) said they believed, wrongly, that the medications were formally approved by the F.D.A. to treat illnesses other than cancer.

More Than 50% Of Patients At Risk For Accidental Overdoses

Just over half of patients prescribed the drugs were not already taking a round-the-clock opioid regimen, and therefore were susceptible to an accidental overdose, according to an analysis of commercial health plan claims for more than 25,000 patients by the industry group in 2016. A follow-up analysis had a similar result.

In fact, in an effort to address “concern regarding patient access,” the industry group in 2013 had taken steps to make it easier to prescribe to patients without opioid tolerance.The group removed protective language from a mandatory patient-prescriber agreement form attesting that the “patient is opioid tolerant,” and instead required a prescriber only to indicate that “I understand” the meaning of opioid tolerance.

The form was also altered to omit a clause that had required patients to affirm that they were already using a round-the-clock opioid regimen.

“It is not open for debate that the risk of these drugs among patients who lack tolerance is unacceptably high. It’s quite clear-cut,” said Dr. Caleb Alexander, a physician who co-directs the Center for Drug Safety and Effectiveness at Johns Hopkins University and led the research on the documents.

According to an internal F.D.A. memo, the agency and the industry group held several teleconferences in 2017 to discuss plans to study adverse events in patients who were not opioid-tolerant, as well as accidental poisonings of children.

With companies “actively subverting” the oversight and safety program, the F.D.A. had authority to mandate a substantial reformation of it, said Dr. Joshua M. Sharfstein, a former principal deputy commissioner of the agency now at Johns Hopkins, who reviewed the documents.

The agency could have sharpened prescriber training programs and agreement forms, he said, or investigated prescribers. At the least, he and other researchers said, the agency could have made the data from the program public.

“With poor transparency and accountability, policymakers and patients are left guessing,” Dr. Alexander said. “This could have all come out years ago.”

Scott Gottlieb, the commissioner of the F.D.A., said in a statement: “We’re taking the issue of how we manage the safe use of these products to our advisory committee, to bring transparency to what we know about how well these post market safety programs are working and to get their advice on how we could strengthen these restrictions to better protect patients.”

The F.D.A. has taken a hands-off approach in the past. The agency tasked Purdue Pharma in the early 2000s with leading a risk management program for OxyContin, its own product.

In 2007, the company pleaded guilty and paid more than $600 million in fines related to misleading marketing.

When the narcotic pain reliever tramadol was approved by the F.D.A. in 1995, it allowed Ortho-McNeil of Johnson & Johnson to fund a steering committee to monitor drug abuse instead of classifying the drug as a controlled substance.

After two decades of mounting abuse, tramadol was reclassified as a controlled substance in 2014.

In recent years, drug companies have faced legal action for falsely advertising T.I.R.F.s. Cephalon paid over $400 million in fines for false marketing of its products, including its T.I.R.F. lollipops, called Actiq, to treat migraines.

The owner of Insys Therapeutics, which makes Subsys — and five prescribing doctors — were charged in a bribery scheme to boost off-label prescribing. McKesson, the distributor, paid a $150 million settlement for failing to report suspicious opioid orders.

Carolyn Markland of Jacksonville, Fla., wanted to be able to lift her grandchildren despite a degenerative spinal disease.

Her doctor prescribed a dose of Subsys to her in July 2014. Ms. Markland suffered respiratory distress the following morning and died of drug toxicity, according to court documents.

Joey Caltagirone of Philadelphia was prescribed his first of almost 6,000 Actiq lollipops for migraines in 2005, when he was 30. He developed a lasting addiction, was prescribed methadone to curtail it, and died of methadone toxicity in 2014, according to court records.

Deborah Fuller, Sarah’s mother, is still struggling with the loss of her daughter.

“If she had died from disease, I wouldn’t be as angry,” she said. “But knowing how she died — and the manipulation that went on — I get angry. I just don’t know what to do with all that anger.”

One of today’s most deadly substances, Fentanyl is showing up everywhere, even in litter on playgrounds. ROR’s pop-graphic Fentanly Poster is a smart way to keep the public informed. Perfect for libraries, doctors offices, schools, and government buildings.

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Dementia: Both Too Much And Too Little Alcohol May Raise Risk

From Science Daily:

People who abstain from alcohol or consume more than 14 units a week during middle age (midlife) are at increased risk of developing dementia, finds a study in The BMJ today.

However, the underlying mechanisms are likely to be different in the two groups.

As people live longer, the number living with dementia is expected to triple by 2050. So understanding the impact of alcohol consumption on ageing outcomes is important.

Previous studies indicate that moderate drinking is associated with a reduced risk of dementia, whereas both abstinence and heavy drinking are associated with a risk of dementia. But the evidence is far from conclusive, and the reasons underlying these associations remain unclear.

So a team of researchers from Inserm (French National Institute of Health and Medical Research) based in France and from UCL in the UK set out to investigate the association between midlife alcohol consumption and risk of dementia into early old age. They also examined whether cardiometabolic disease (a group of conditions including stroke, coronary heart disease, and diabetes) has any effect on this association.

Their findings are based on 9,087 British civil servants aged between 35 and 55 in 1985 who were taking part in the Whitehall II Study, which is looking at the impact of social, behavioural, and biological factors on long term health.

Participants were assessed at regular intervals between 1985 and 1993 (average age 50 years) on their alcohol consumption and alcohol dependence.

Alcohol consumption trajectories between 1985 and 2004 were also used to examine the association of long term alcohol consumption and risk of dementia from midlife to early old age.

Admissions for alcohol related chronic diseases and cases of dementia from 1991, and the role of cardiometabolic disease were then identified from hospital records.

Of the 9,087 participants, 397 cases of dementia were recorded over an average follow-up period of 23 years. Average age at dementia diagnosis was 76 years.

After taking account of sociodemographic, lifestyle, and health related factors that could have affected the results, the researchers found that abstinence in midlife or drinking more than 14 units a week was associated with a higher risk of dementia compared with drinking 1-14 units of alcohol a week. Among those drinking above 14 units a week of alcohol, every 7 unit a week increase in consumption was associated with 17% increase in dementia risk.

In the UK, 14 units of alcohol a week is now the recommended maximum limit for both men and women, but many countries still use a much higher threshold to define harmful drinking.

History of hospital admission for alcohol related chronic diseases was associated with a four times higher risk of dementia.

In abstainers, the researchers show that some of the excess dementia risk was due to a greater risk of cardiometabolic disease.

Alcohol consumption trajectories showed similar results, with long term abstainers, those reporting decreased consumption, and long term consumption of more than 14 units a week, all at a higher risk of dementia compared with long term consumption of 1-14 units a week.

Further analyses to test the strength of the associations were also broadly consistent, suggesting that the results are robust.

Taken together, these results suggest that abstention and excessive alcohol consumption are associated with an increased risk of dementia, say the researchers, although the underlying mechanisms are likely to be different in the two groups.

This is an observational study, so no firm conclusions can be drawn about cause and effect, and the researchers cannot rule out the possibility that some of the risk may be due to unmeasured (confounding) factors.

The authors say their findings “strengthen the evidence that excessive alcohol consumption is a risk factor for dementia” and “encourage use of lower thresholds of alcohol consumption in guidelines to promote cognitive health at older ages.” They also say these findings “should not motivate people who do not drink to start drinking given the known detrimental effects of alcohol consumption for mortality, neuropsychiatric disorders, cirrhosis of the liver, and cancer”

This study is important since it fills gaps in knowledge, “but we should remain cautious and not change current recommendations on alcohol use based solely on epidemiological studies,” says Sevil Yasar at Johns Hopkins School of Medicine, in a linked editorial.

She calls for further studies and ideally a government funded randomized clinical trial to answer pressing questions about the possible protective effects of light to moderate alcohol use on risk of dementia and the mediating role of cardiovascular disease with close monitoring of adverse outcomes.

In summary, she says, “alcohol consumption of 1-14 units/week may benefit brain health; however, alcohol choices must take into account all associated risks, including liver disease and cancer.”

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What Causes Alcohol Addiction? Study Investigates

Is a faulty signaling mechanism in the brain area that processes emotion the reason that only a minority of those who drink alcohol become addicted to it?

Why do only some people become addicted to alcohol?

Researchers in Sweden and the United States suggest that this might be the case after studying alcohol addiction in rats.

They found that the rats that became addicted had an impaired brain mechanism similar to that seen in postmortem brain tissue from humans who were addicted to alcohol.

The faulty mechanism is a failure to clear away a substance known as gamma-Aminobutyric acid (GABA) that inhibits signaling around neurons, or brain cells, in the central amygdala.

The amygdala is a region of the brain concerned with emotion, learning, memory, and motivation.

The scientists report their findings in a paper now published in the journal Science.

Disrupted ‘motivational control’

The authors explain that, of people who are exposed to alcohol, around 10–15 percent “develop alcohol-related problems.”

In their study, they found that a similar proportion (15 percent) of the rats that were exposed to alcohol persisted with alcohol-seeking and became addicted.

The rats continued to dose themselves with alcohol even when a “high-value” option, such as sugared water, was made available to them.

Most of the rats switched over to sugared water when given the option, but the persistent minority continued to dose themselves with alcohol. This was in spite of the fact that pressing the lever to get the substance also delivered a slight electric shock to the paw.

The team observed that the alcohol-seeking animals behaved in a similar way to humans who are addicted to alcohol. The rodents were highly motivated to get alcohol, even though there were negative consequences and another reward option.

“We have to understand,” explains senior study author Markus Heilig, who is a professor in clinical and experimental medicine at Linköping University in Sweden, “that a core feature of addiction is that you know it is going to harm you, potentially even kill you, and nevertheless something has gone wrong with the motivational control and you keep doing it.”

Signaling problem in the amygdala

When the researchers looked inside the rats’ brains, they discovered what might be disrupting the “motivational control.” First, they looked for differences in gene expression in different parts of the brain. The biggest differences were in the amygdala.

They revealed that the gene that codes for a protein called GAT-3 was expressed at much lower levels in the amygdala of the rats that continued to choose alcohol compared with the rats that switched to sugared water.

GAT-3 is a “transporter” protein that helps to clear away GABA from around neurons. Studies have also revealed that rats that become addicted to alcohol seem to have altered GABA signaling.

To confirm that the GAT-3 gene was at fault, the scientists ran another experiment in which they silenced GAT-3 in the rats that had switched over to sugared water in preference to alcohol.

The effect was striking: the GAT-3 silenced rats began to behave similarly to their alcohol-seeking counterparts. When they were again given a choice between dosing themselves with alcohol or sugared water, they chose alcohol.

Human alcoholism has same brain feature

Finally, in collaboration with a team from the University of Texas at Austin, the researchers analyzed GAT-3 levels in human postmortem brain tissue. They found that GAT-3 levels were lower in tissue taken from individuals with “documented alcohol addiction.”

The scientists believe that the findings will lead to improved treatments for alcohol dependence.

An investigation into the potential of using the muscular tension drug baclofen to treat alcohol dependence has shown some promising results but has not been able to explain what the mechanism of action might be.

“One of the things baclofen does is to suppress GABA release,” Prof. Heilig explains, adding:

“We are currently working with a drug company to try to develop a second-generation molecule as a candidate for alcoholismmedication that targets this signaling pathway.”

Prof. Markus Heilig

 

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4 Ways To Get An A In Stress Management

From Helpguide: While stress is an automatic response from your nervous system, some stressors arise at predictable times—your commute to work, a meeting with your boss, or family gatherings, for example. When handling such predictable stressors, you can either change the situation or change your reaction. When deciding which option to choose in any given scenario, it’s helpful to think of the four A’s: avoid, alter, adapt, or accept.

1. Avoid

It’s not healthy to avoid a stressful situation that needs to be addressed, but you may be surprised by the number of stressors in your life that you can eliminate.

Learn how to say “no.” Know your limits and stick to them. Whether in your personal or professional life, taking on more than you can handle is a surefire recipe for stress. Distinguish between the “shoulds” and the “musts” and, when possible, say “no” to taking on too much.

Avoid people who stress you out. If someone consistently causes stress in your life, limit the amount of time you spend with that person, or end the relationship.

Take control of your environment. If the evening news makes you anxious, turn off the TV. If traffic makes you tense, take a longer but less-traveled route. If going to the market is an unpleasant chore do your grocery shopping online.

Pare down your to-do list. Analyze your schedule, responsibilities, and daily tasks. If you’ve got too much on your plate, drop tasks that aren’t truly necessary to the bottom of the list or eliminate them entirely.

2. Alter

If you can’t avoid a stressful situation, try to alter it. Often, this involves changing the way you communicate and operate in your daily life.

Express your feelings instead of bottling them up. If something or someone is bothering you, be more assertive and communicate your concerns in an open and respectful way. If you’ve got an exam to study for and your chatty roommate just got home, say up front that you only have five minutes to talk. If you don’t voice your feelings, resentment will build and the stress will increase.

Be willing to compromise. When you ask someone to change their behavior, be willing to do the same. If you both are willing to bend at least a little, you’ll have a good chance of finding a happy middle ground.

Create a balanced schedule. All work and no play is a recipe for burnout. Try to find a balance between work and family life, social activities and solitary pursuits, daily responsibilities and downtime.

3. Adapt

If you can’t change the stressor, change yourself. You can adapt to stressful situations and regain your sense of control by changing your expectations and attitude.

Reframe problems. Try to view stressful situations from a more positive perspective. Rather than fuming about a traffic jam, look at it as an opportunity to pause and regroup, listen to your favorite radio station, or enjoy some alone time.

Look at the big picture. Take perspective of the stressful situation. Ask yourself how important it will be in the long run. Will it matter in a month? A year? Is it really worth getting upset over? If the answer is no, focus your time and energy elsewhere.

Adjust your standards. Perfectionism is a major source of avoidable stress. Stop setting yourself up for failure by demanding perfection. Set reasonable standards for yourself and others, and learn to be okay with “good enough.”

Practice gratitude. When stress is getting you down, take a moment to reflect on all the things you appreciate in your life, including your own positive qualities and gifts. This simple strategy can help you keep things in perspective.

4. Accept

Some sources of stress are unavoidable. You can’t prevent or change stressors such as the death of a loved one, a serious illness, or a national recession. In such cases, the best way to cope with stress is to accept things as they are. Acceptance may be difficult, but in the long run, it’s easier than railing against a situation you can’t change.

Don’t try to control the uncontrollable. Many things in life are beyond our control—particularly the behavior of other people. Rather than stressing out over them, focus on the things you can control such as the way you choose to react to problems.

Look for the upside. When facing major challenges, try to look at them as opportunities for personal growth. If your own poor choices contributed to a stressful situation, reflect on them and learn from your mistakes.

Learn to forgive. Accept the fact that we live in an imperfect world and that people make mistakes. Let go of anger and resentments. Free yourself from negative energy by forgiving and moving on.

Share your feelings. Expressing what you’re going through can be very cathartic, even if there’s nothing you can do to alter the stressful situation. Talk to a trusted friend or make an appointment with a therapist.

Did you know the 12 Steps, which have helped millions find recovery, can also help their loved ones find peace and serenity? Check out our latest book, Find Your True Colors In 12-Steps.

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Government’s Answer To Opioid Crisis Feels Like War To Pain Patients

From Art Levine @ The Huffington Post: As the feds crack down on opioid prescriptions, patients are taking their own lives, doctors are losing their jobs and overdose rates continue unabated.

Jay Lawrence, an energetic truck driver in his late 30s, was driving a semitrailer across a bridge when the brakes failed. To avoid plowing into the car in front of him, he swerved sideways and slammed the truck into a wall, fracturing his back. For more than 25 years, he struggled with the resulting pain. But for most of that time, he managed to avoid opioid painkillers.

In 2006, his legs suddenly collapsed beneath him, due to a complex web of neurological factors related to his spinal cord injury. He underwent multiple surgeries and tried many medications to alleviate his pain.

The next year, he began to experience some semblance of relief when his doctor prescribed morphine, one of a class of opioid drugs. By 2012, he was taking 120 milligrams per day.

But this isn’t a story about opioid addiction. Lawrence managed a relatively productive, happy life on the medication for the better part of 10 years.

“This isn’t the life I thought I’d have,” he told his wife, Meredith Lawrence, in December 2016. “But I’m all right.”

Living on disability payments, he could still walk around their two-bedroom trailer home using his cane, take a shower on his own and, on his good days, even help his wife make breakfast.

Then, in early 2017, the pain clinic where he was a patient adopted a strict new policy, part of a wide-ranging national effort to respond to the increase in opioid overdose deaths.

Citing 2016 guidelines from the U.S. Centers for Disease Control and Prevention, her husband’s doctor abruptly cut his daily dose by roughly 25 percent to 90 mg, Meredith Lawrence said. That was the maximum dose the CDC recommends, though does not mandate, for first-time opioid patients.

The doctor also told Jay Lawrence that the plan was to lower his dose to 45 mg over the next two months, a cutback of more than 60 percent from what he had been taking.

At the end of that traumatic visit, his wife said, Jay Lawrence’s doctor dismissed their concerns and shared his own fear about losing his license if he continued to prescribe high doses of opioids. (When HuffPost followed up, the doctor declined to comment on the case, citing patient privacy.)

For a month, Lawrence suffered on the 90 mg dose. At times, his pain was so bad that he needed help to get out of the recliner, and when his wife looked over, she sometimes saw tears streaming down his face. He dreaded his next appointment when his dose would be slashed to 60 mg. In the weeks before that scheduled visit on March 2, 2017, Lawrence came up with a plan.

On the day of his appointment, on the same bench in the Hendersonville, Tennessee, park where the Lawrences had recently renewed their wedding vows, the 58-year-old man gripped his wife’s hand and killed himself with a gun.

9 Million Americans Are Chronic Pain Patients

There are at least nine million chronic pain patients in the United States who take opioid painkillers on a long-term basis. As law enforcement and medical regulatory bodies try to curb the explosion in opioid deaths and the rise in illegal opioid use, they have focused on reducing the overall opioid supply, whether or not the drugs are provided by prescription.

There’s mounting evidence this won’t work ― that curbing patient access to legal prescription opioids does not stem the rate of overdoses caused primarily by illegal drugs ― and that patients are being denied desperately needed relief. There are also troubling indicators that cutting back on opioids increases the risk of suicide among those with chronic pain.

Some chronic pain patients and advocates have even begun compiling lists of individuals they know who have died by suicide after they were no longer able to treat their pain with opioid medication.

“There is no doubt in my mind that forcibly stopping opioids can destabilize some of the most vulnerable people in America,” said Dr. Stefan Kertesz, a professor of medicine and an addiction researcher at the University of Alabama at Birmingham. “And the outcomes for those folks include suicide, overdose and falling apart medically.”

“I mean, people need to take some aspirin sometimes and tough it out a little.” Attorney General Jeff Sessions

For a decade or so, government officials in the U.S. have sought to drive down the opioid supply through a range of tactics ― from increased seizures of diverted opioid medications to state crackdowns on “pill mills.” The Trump administration has embraced the hard-line approach.

In late January, Attorney General Jeff Sessions announced a “surge” in Drug Enforcement Administration activity targeting pharmacies and physicians that, in the agency’s view, oversupply opioids. In February, the Justice Department doubled down with the announcement of a new task force that would focus on manufacturers and distributors of opioids. In March, President Donald Trump unveiled a plan to lower opioid prescriptions by a third within three years. And in late June, the federal government arrested 600 people, including 165 medical professionals, for allegedly participating in $2 billion worth of fraud schemes involving opioids.

The Trump administration’s efforts are dramatic even within the context of the CDC’s opioid dose guidelines. The guidelines were originally intended to advise primary care physicians treating chronic pain patients and other pain sufferers. They were urged to exercise caution in prescribing opioids, to use alternatives whenever possible and to prescribe daily doses of no more than 90 morphine milligram equivalents (MME) for new opioid users.

For pain patients like Jay Lawrence who had already been on opioids for years, however, the guidelines simply recommended regularly assessing the harms and benefits of the dosage. They didn’t advise either mandatory cutoffs or any set limits. (The Tennessee Department of Health’s guidelines would also have allowed Lawrence to stay at 120 mg of morphine when prescribed by a pain specialist.)

But “the CDC guidelines have been weaponized,” said Kertesz. The ramped-up enforcement by the DEA and state regulators has led some doctors to choose caution and to overcorrect in their prescribing, lest they lose their ability to practice medicine at all. Kertesz decried these policies as “simplistic” in a definitive new article published last week in the journal Addiction.

In February, Sessions struck a particularly harsh tone by suggesting that the fate of chronic pain patients was not high on his list of concerns. “I am operating on the assumption that this country prescribes too many opioids,” the attorney general said. “I mean, people need to take some aspirin sometimes and tough it out a little.”

Attitudes like that are based on a series of mistaken assumptions about pain, according to Dr. Thomas Kline, a North Carolina-based family practitioner and former Harvard Medical School program administrator. Kline regularly updates a list of pain patients, published on Medium, who’ve killed themselves in the wake of draconian restrictions on pain medication.

“I ask people to imagine the very worst pain they’ve ever experienced in their lives,” Kline said. “And then that they’re denied relief by a doctor with the one medicine proven effective for pain control for 50 centuries.” (Historical records show that people in ancient Mesopotamia cultivated the poppy plant for medical use.)

“The CDC guidelines have been weaponized.” Dr. Stefan Kertesz

The government’s aggressive focus on doctors and patients is unlikely to address the very real menace of opioid-use disorders and sharply escalating overdose deaths. Fraud ― driven by pharmaceutical company policies ― and diversion ― the phenomenon of prescription medications being sold as street drugs ― initially spurred a wave of opioid abuse in the late 1990s, as some doctors turned their practices into pill mills. But new reports by the CDC and a drug data firm, the IQVIA Institute for Human Data Science, suggest that prescription drugs play a much smaller role in today’s crisis.

The reports show that total opioid prescriptions dropped 10 percent in 2017 ― the sharpest annual decline in such prescribing in 25 years. While opioid prescriptions peaked back in 2010, the studies found that growth rates in opioid-linked deaths, overwhelmingly due to illegal fentanyl and heroin, have skyrocketed in the last seven years.

Indeed, although two-thirds of the 64,000 overall drug overdose fatalities were linked to opioids in 2016 ― the most recent year for which there is data ― more than 80 percent of those opioid drug deaths came from illegal street drugs such as heroin and fentanyl. Prescription opioid drug deaths alone ― excluding methadone ― amounted to less than 15 percent of all drug overdose deaths, or about 9,500 fatalities.

Still, the CDC’s guidelines have triggered restrictive laws in at least 23 states that mandate ceilings on opioid dosage. (Oregon, in fact, is moving to taper dosages down to zero for all Medicaid chronic patients over a year.) That makes relief less attainable for pain patients and threatens the practices of doctors who treat them. These laws have been augmented by the growth of state prescription monitoring programs that use the software NarxCare, which is designed to flag addiction but can also rope in pain patients based on their prescription history and use of multiple doctors.

And in June, the House of Representatives passed over 50 bills that would establish dramatic new restrictions on opioid prescribing, eliciting alarm among patients and some disability rights groups.

The side effects of the current enforcement efforts are disturbing enough, from patients denied relief to drug shortages to suicides.

No health agency has kept track of all pain-related suicides that may be linked to doctors cutting back on prescriptions. But some preliminary findings from Department of Veterans Affairs researchers indicate that VA pain patients deprived of opioids were two to four times more likely to die by suicide in the first three months after they were cut off, compared to those who remained on their pain medications.

That study isn’t without flaws. Veterans die by suicide at higher rates than average ― currently accounting for 20 suicide deaths a day ― so they are not a nationally representative sample. And the VA study, which was released at a national opioid summit in early April, has not yet been submitted for peer review.

But another study, published last year in the peer-reviewed journal General Hospital Psychiatry, looked at nearly 600 veterans who in 2012 were cut off from dosages after long-term opioid use and found similar results. Twelve percent of the vets showed suicidal ideation or took violent action to harm themselves ― a rate nearly 300 percent higher than the overall veterans community.

“To protect people, you have to take care of the patient, not the pill count,” said Kertesz, who worked on the VA’s April 2017 study but spoke to HuffPost only as an independent researcher. “The findings suggest that the discontinuation of opioids doesn’t necessarily assure a safer patient.”

Even terminally ill cancer patients are increasingly getting less relief, and there are growing shortages of injectable opioids at local hospitals and hospices, spurred in part by DEA-ordered reductions in opioid manufacturing quotas.

Leah Ilten, a 53-year-old physical therapist who lives in Kennewick, Washington, told HuffPost that as her 86-year-old father lay dying of pancreatic cancer in a hospice, the medical staff ignored her pleas to provide appropriate opioid pain relief, even cutting his dosage in half on the last day of his life. A few days earlier, when he was in the hospital, one nurse explained to her that opioids could lead to an overdose or could potentially cause the man, who lay moaning in pain, to “get addicted.”

“I was horrified,” Ilten said.

In mid-April, the DEA responded to the injectable opioid shortage by lifting production quotas. An agency spokesman told HuffPost that it was “a manufacturers’ problem, not the quotas,” while asserting that progress is being made.

There have been production issues, including Pfizer’s foul-ups with a plant in Kansas. But the DEA’s delay in taking action ― shortfalls were flagged in February in a letter from the American Society of Anesthesiologists and other health groups ― definitely contributed to the shortage, according to Dr. James Grant, president of the ASA. He told HuffPost that quotas were among the factors creating the crisis.

“I’m not willing to go back to the state I was in before I started treatment.” Anne Fuqua

Faced with the hardline national crackdown on opioid prescriptions, people with chronic pain are trying to raise awareness of the suffering caused by the loss of medications. Some are gathering the names of those patients who ended up taking their own lives, both as a memorial to those who died and as a protest against the health establishment that has seemingly abandoned them. Others are seeking comfort from each other on social media.

Lelena Peacock, who declined to name her southeastern city of residence for fear of retaliation from doctors, is struggling with how to treat the pain associated with fibromyalgia. The 45-year-old found that her social media posts drew other pain patients who turned to her for help.

By her own count, Peacock has thus far convinced more than 70 chronic pain patients to call 911 or suicide prevention hotlines instead of killing themselves.

For Anne Fuqua, a 37-year-old former nurse from Birmingham, Alabama, the motivation for compiling a list of chronic pain-related suicides is to track the damage done by what she sees as policies that have left people like her behind.

“There’s so many people who have died,” she said. “We have to remember them.”

Fuqua has an incurable neurological illness known as primary generalized dystonia that causes Parkinson’s-like involuntary movements and painful muscle spasms. She started taking about 60 mg of Oxycontin a day in 2000. Her doctor began to limit her access to high doses of opioids in 2014, the same year she started chronicling those friends who had killed themselves or otherwise died after being denied pain medications. Her informal list is now up to roughly 150 people, augmented by lists that other pain patient advocates have compiled.

On July 9, Fuqua joined other chronic pain patients at a meeting at the Food and Drug Administration campus in Maryland to express their fears and outrage at the cutbacks. Sitting in the front row in her wheelchair, she told FDA officials about that list and declared, “I’m not willing to go back to the state I was in before I started treatment.”

Fuqua’s own difficulties are compounded by the fact that her body does not respond to even large doses of opioids the way others do ― she suffers from severe malabsorption that hampers her ability to benefit from everything from opioids to vitamin D. Since 2012, she has relied on a strikingly high daily regimen of 1,000 MME of opioids, including fentanyl patches, to manage her pain.

But her physician, Dr. Forrest Tennant, was driven to retire this year after a DEA raid and investigation. The Los Angeles-area physician mailed her a final series of prescriptions, which will run out at the end of July.

“It’s terrifying,” she said looking at her future. “If these were people who had asthma or diabetes and weren’t stigmatized because of opioids, this wouldn’t be allowed to happen.”

Another doctor has quietly stepped forward to continue treatment for Tennant’s remaining patients, Fuqua said, although there’s no assurance that this physician won’t also be investigated in the future.

“If these were people who had asthma or diabetes and weren’t stigmatized because of opioids, this wouldn’t be allowed to happen.” Anne Fuqua

The raid on Tennant’s home and office last November illustrates the hard-line regulatory and enforcement approach that critics say doesn’t distinguish between pill-mill doctors who deserve to be shut down and legitimate pain doctors who use high-dosage opioids. The wide-ranging search warrant served to Tennant essentially accused him of drug trafficking even though he’d earned a national reputation for deft treatment of ― and research about ― pain patients.

“He’s highly respected and prominent in pain management,” said Jeffrey Fudin, a clinical pharmacy specialist who heads the pain pharmacy program at the Albany Stratton VA Medical Center in Albany, New York, and serves as an associate professor at the Albany College of Pharmacy and Health Sciences. “Most of his patients had no other options, and they came from around the country to see him.”

Tennant was known for taking on difficult-to-treat patients, including those suffering from pain as a result of botched surgeries and other forms of malpractice. His research included innovations in the use of hormones to alleviate pain and lower opioid use up to 40 percent, as well as work on genetic testing for enzyme system defects that lead to opioid malabsorption.

“The DEA can trigger an investigation every time they misapply the CDC guidelines without paying attention to the population the physician treats or issues of medical necessity,” said Terri Lewis, a patient advocate and a Ph.D. clinical rehabilitation specialist with Southern Illinois University who trains clinicians on how to manage seriously ill patients with incurable pain.

Special Agent Timothy Massino, a spokesperson for the DEA’s Los Angeles division, declined to comment on the agency’s approach to Tennant. “It’s an ongoing investigation,” he noted.

Tennant’s isn’t alone. Physicians must now balance their prescribing obligations to their patients with legitimate fear for their livelihoods.

DEA enforcement actions against doctors have risen some 500 percent in recent years ― from 88 in 2011 to 449 last year, according to an analysis of the comprehensive National Practitioners Data Bank by Tony Yang, a professor of health policy at George Washington University. Even though that’s a relatively small number of arrests compared to the roughly one million physicians in the country, such arrests can have an outsized impact.

“They make big news, and they serve as a deterrent for physicians whose specialties require them to use a lot of pain medications,” Yang said. “It makes them think twice before prescribing opioids.”

Dr. Mark Ibsen of Helena, Montana, found himself in a five-year battle against the state licensing board that’s still not over ― even though a judge last month reversed the board’s decision to suspend his license because of due process violations. The court has remanded the case back to the licensing board for potential further investigation of his opioid prescriptions, but Ibsen has decided he won’t resume his medical practice.

That’s bad news for Montana, which has the highest rate of suicide in the country, according to the CDC. What’s more, chronic pain-related illnesses account for 35 percent of all the state’s suicides, as a recent state health department study found.

In the course of his fight with the medical board, the 63-year-old doctor said three of his former chronic pain patients have killed themselves after he and other doctors stopped prescribing opioids. The first of those patients died shortly after attending a hearing to show his support for Ibsen.

The deaths of pain patients haunt those who treated them and loved them. Meredith Lawrence, who sat with her husband to the very end, said, “It was as horrifying as anything you can imagine.”

“But I had the choice to help him or find him dead someday when I came home,” she added.

Lawrence was arrested and sentenced to a year’s probation for assisting a suicide. Now her goal is to fight restrictions on opioid prescriptions.

“If we don’t stand up, more people will die like my husband.”

If you or someone you know needs help, call 1-800-273-8255 for the National Suicide Prevention Lifeline. You can also text HOME to 741-741 for free, 24-hour support from the Crisis Text Line. Outside of the U.S., please visit the International Association for Suicide Prevention for a database of resources.

Art Levine is the author of Mental Health, Inc: How Corruption, Lax Oversight, and Failed Reforms Endanger Our Most Vulnerable Citizens.

Did you know the 12 Steps, which have helped millions find recovery, can also help their loved ones find peace and serenity? Check out our latest book, Find Your True Colors In 12-Steps.

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Anthony Hopkins Says Religion Saved Him From Alcoholism

From Kara Warner @ People: Although Sir Anthony Hopkins has won dozens of awards for acting, he recently admitted that his chosen career was almost an accident — and that it was almost derailed by alcohol addiction.

According to The Hollywood Reporter, Hopkins opened up about his struggles with alcoholism during a guest talk on behalf of student leadership organization the LEAP Foundation (Leadership, Excellence and Accelerating Your Potential), and revealed that religion saved him from himself.

After admitting that he started acting because he “had nothing better to do,” Hopkins, 80, said his drinking became a problem while working in theater, “because that’s what you do in theater, you drink.”

The Oscar winner conceded that he “was very difficult to work with, as well, because I was usually hungover,” and that the turning point for him came courtesy the advice from a woman at an Alcoholics Anonymous meeting in December 1975.

“[She said] why don’t you just trust in God?” Hopkins recalled, and that his desire to drink virtually dissolved right then and there, “never to return.”

Hopkins went on to encourage his audience, comprised of nearly 500 high school and college students, to believe in themselves and say “yes” to things.

“I believe that we are capable of so much,” Hopkins said. “From my own life, I still cannot believe that my life is what it is because I should have died in Wales, drunk or something like that.”

The Welsh actor continued,

“We can talk ourselves into death or we can talk ourselves into the best life we’ve ever lived. None of it was a mistake. It was all a destiny.”

The Westworld star will next appear in the upcoming Netflix drama Pope, as Pope Benedict, opposite Jonathan Pryce as Pope Francis.

Did you know the 12 Steps, which have helped millions find recovery, can also help their loved ones find peace and serenity? Check out our latest book, Find Your True Colors In 12-Steps.

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5 Strategies For Dealing With Difficult Parents

From Lana Adler @ We Have Kids: It could be your biological parent, or perhaps toxic in-laws, but the effect they have on you is the same: hurt, confusion, disappointment, anger and desire to withdraw. This article will discuss how to deal with difficult parents, and when to let go.

1. Put Things in Perspective

“The most loving parents and relatives commit murder with smiles on their faces. They force us to destroy the person we really are: a subtle kind of murder.” ― Jim Morrison

Even the most loving parents damage their children with the best intentions – to protect them, to guide them, to better them. In most cases, by imprinting their own fears and prejudices on them.

The point is, parents are just people. People with flaws, struggles and impaired judgement. People with emotional or intellectual handicaps. People with personal blockages and limitations regardless of their parental role. People who make mistakes and who are terrified of being judged by their children.

Learn to see your difficult parent as just human. Learn to see their emotional immaturity as a type of disability.

2. Keep Expectations Low

In many ways the effect a difficult parent has on us is fueled by our feelings of injustice (being wronged) and the belief that things could be different, or should be different. In other words, our expectations dictate how we feel.

You need to let go of your expectations and accept your parent(s) for who they are. You can’t expect someone with, say, a narcissistic personality disorder to act with empathy and kindness. No more than you can expect a scorpion not to sting.

Difficult parents are waaaaay easier to deal with when you accept that they won’t change. So don’t expect of them more than they are capable of, and you won’t be disappointed or hurt.

3. Don’t Fall Into the Guilt Trap

Difficult parents love making you feel like you’ve hurt them. Or, in a different scenario, you’re a bad person if you don’t do something they ask.

Don’t fall for it. If they’re setting a guilt trap, calmly tell them that you don’t appreciate being emotionally manipulated, and you won’t tolerate it anymore. Manipulators don’t like being called out on their dirty tricks.

If they continue to harass you, reiterate that you can’t do what they’re asking you to do this time, and you need them to respect that. The trick is agreeing with everything they’re saying (how can they argue when you agree with them?) and re-stating your decision over and over again.

4. Be Direct And Assertive When Confronting A Difficult Parent

When confronting a difficult parent, be direct and calm without expecting a specific response. That’s the part you can’t control.

The part that is up to you is letting your thoughts and feelings known, which is empowering.

Stick to the facts and use “I” statements (i.e., “I feel like my words don’t matter to you when you constantly interrupt me” or “We appreciate your concern and all your help but we won’t be needing you to move in with us after the baby is born”).

Remember that manipulative parents are not known for their empathy. They will try to confuse you, go on the offensive, or assume the role of a victim – something they do a lot.

Don’t let them bully you into submission by invoking guilt or pity. State your case in a calm and polite manner, and stay cool regardless of their response. Your goal is to be honest about your feelings, and to make it clear that you won’t tolerate certain behaviors.

5. Consider Forgoing The Relationship That’s Too Harmful

“An unhappy alternative is before you, Elizabeth. From this day you must be a stranger to one of your parents. Your mother will never see you again if you do not marry Mr. Collins, and I will never see you again if you do.” ― Jane Austen, “Pride and Prejudice”

A parent isn’t someone you can easily cut out of your life. But if all else fails and your difficult parent continues to cause you psychological harm, consider forgoing a relationship altogether, at least for the foreseeable future.

In some cases it’s the only logical recourse. A parent who is fundamentally incapable of showing love and support, who is unable to see the error of their ways after numerous attempts to communicate how their behavior or words affect you, someone who is consistently abusive, demeaning or critical – that parent is a destructive force that will continue to tear you down until you put a stop to it.

It’s not an easy feat – the parent-child bond is hard-wired into our brains, which means children get attached to even the most awful parents. But consider the cost of having that toxic relationship in your life – stress, anxiety, depression, internalized feelings of inadequacy, failed personal relationships, not to mention thousands of dollars worth of therapy.

Maybe one day they will change. Right after Jesus descends unto Earth in a golden chariot, riding a couple of unicorns. Anything’s possible. But until then, consider all options, including cutting them loose.

Did you know the 12 Steps, which have helped millions find recovery, can also help you deal with difficult people? Check out our latest book, Find Your True Colors In 12-Steps.

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5 Ways To Repair Your Self-Esteem

From Amée LaTour @ Good Choices Good Life: “Don’t rely on someone else for your happiness and self-worth. Only you can be responsible for that. If you can’t love and respect yourself – no one else will be able to make that happen. Accept who you are – completely; the good and the bad – and make changes as YOU see fit – not because you think someone else wants you to be different.” – Stacey Charter

You are much more than the situations in your life and the judgments of those around you. A big part of what defines you is how you react, adapt and respond to such circumstances. There are things you can do, here and now, to change how you feel about yourself. The first step is to realize, as Stacey Charter says in the quote above, that this can only come from within you. Raising your self-esteem will require a combination of changing the way you think and changing what you do. Consider the following ways to deal with low self-esteem.

1. Come To Terms With Uninvolved/Negligent Authority Figures.

The first thing here is to acknowledge that adults often have issues of their own. If your parents or guardians aren’t able to properly care for you or give you support and attention – be it from mental health or substance abuse issues or some other cause – it is absolutely, positively, 100% not your fault. It’s also not an accurate reflection of your worth. If you’re in the unfortunate circumstance of not being cared for properly by a parent or guardian, it’s important for you to consider that the way you’re being treated is not of your doing and is, in fact, undeserved.

Coming to terms with uninvolved authority figures doesn’t mean not caring and not hurting because of them. You’ll probably always care, and it may always hurt. But it doesn’t have to define you. Self-esteem comes from you – not others, not even those who are supposed to care for us most.

That doesn’t mean that supportive and caring authority figures aren’t important. You can seek out such people from youth organizations like a local YMCA, a Boys & Girls Club or an after school program. People who work and volunteer for these services do so because they care about young people. So, if you are not getting support at home, make use of these external resources.

2. Pick Positive Peers.

You’re in control of who you give your time and energy to. It’s easy to pick friends based on who’s most popular; while this crowd may boost your social status, it can also clobber your self-esteem when your “friends” put you down or encourage you to do things you’re not comfortable with or proud of. You need friends you can be yourself with, who value the person you really are. Surrounding yourself with supportive friends who care about you can help you maintain a healthy level of self-esteem. If you have to make a friendship change – or several of them – to put yourself in a better place as far as such influence is concerned, do it – the sooner the better.

3. Get Help For Trauma.

Counseling for trauma is very important. If you’re not comfortable talking with parents or guardians about trauma, consider asking them if you can see a therapist or counselor for reasons you’d rather reserve for private sessions. If someone in your home is hurting you or has hurt you, consider talking with a school guidance counselor or other trusted adult about it.

Another resource young adults can make use of discretely is the Boys Town National Hotline (for boys, girls and parents). You can call 1-800-448-3000 anytime, any day to speak with a trained counselor about anything. Boys Town also offers online chat and texting services that teens can make use of. This is a great option for teens who aren’t sure where to go or how to begin dealing with experiences of abuse and other traumatic events.

4. Forgive Yourself.

When we’ve made several bad choices in the past, as described in the last section, we can begin to feel that we’re just “that kind” of person. We lock ourselves into that “role” or “character” and continue to play it unless we interrupt ourselves by remembering that we write our own scripts. What you’ve done in the past does not have to determine your course of action and decision-making from here on out. It’s important to forgive yourself – not to let yourself “off the hook,” but to accept that some of the choices you’ve made were not the best and resolve to do better in the future. Life is generally pretty long, and when you think of how much time you have in front of you to be a better person compared to the time behind you, it’s certainly worth giving yourself that chance.

personal qualities word cloud

5. Challenge Negative Thought Patterns.

Breaking the cycle of negative thought patterns requires some persistence, but the process is fairly simple. Start by identifying negative thoughts – “I can’t do that,” “That person probably hates me,” are some examples. When you have a negative thought, question it. Why do you think that way? You may find that you have no reason to.

Next, work on different ways to interpret situations. “That will be hard, but I can try it out,” or, “I’m not sure how that person feels about me, but I care about him/her and want to work on being friends.” By replacing baseless negative thoughts with more realistic and constructive ones, you give yourself a chance whereas before you would have given up or not tried – you make it possible to prove your old negative thoughts wrong.

Another way to counteract negative thoughts about yourself is to make a list of your strengths. It’s easy to focus on the things we don’t like about ourselves and to ignore the things we may actually love; this prevents us from cultivating our strengths. The first step toward doing so is acknowledging them. Make a list of your strengths (and interests) – this may seem hard, but push yourself to identify as many as you can – at least five. Add your primary or more important interests to this list, things that you might want to do with your life long-term.

The exercise above will help you become more aware of your strengths and interests when you’re exercising them in daily life. Perhaps you’ll find that some of your strengths aren’t getting exercised or you’re not developing your interests; in that case, think about how you can do a better job of focusing on and applying these, and keep your list up-to-date.

The steps above are easier said than done, but you can definitely make some progress if you work at it. Don’t expect to completely reverse your sense of self-worth overnight; working on self-esteem is a process.

Note: This piece has been edited for length. To read the entire original publication, click here.

Did you know the 12 Steps, which have helped millions find recovery, can also help you find peace and serenity? Check out our latest book, Find Your True Colors In 12-Steps.

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