Leslie Glass's Blog, page 387
March 10, 2018
Insurers Are Getting Into Health Care, But Is It Good for You?
Insurers are dropping billions of dollars on acquisitions and expansions in order to get more involved in customer health. They say this push can help cut costs and improve care, in part by keeping the sickest patients healthy and out of expensive hospitals.
That’s a huge potential benefit for employers and other customers stressed by rising costs. But is this good for your health?
That question worries some health care insiders who wonder if the patient’s best interest — and not profits — will remain the focus as insurers dive deeper into care.
“The fights about price and cost are only going to get worse. Now you’ve got more integrated and powerful private insurers … coming up with the answer,” said medical ethicist Arthur Caplan.
The insurer Cigna said Thursday it will spend $52 billion to buy Express Scripts, which administers prescription benefits for about 80 million people.
Late last year, CVS Health also announced a roughly $69 billion deal to buy another insurer, Aetna. Those companies plan to convert drugstores into health care hotspots that people can turn to for a variety of needs in between doctor visits.
Other insurance companies, including Humana and UnitedHealth Group, also are making deals to expand their role in managing or providing care
The concept isn’t new. Many people already have coverage through health maintenance organizations, or HMOs, where insurers either employ doctors or contract with them to manage care.
But major insurers are buying into the idea because the usual ways they control costs — by negotiating rates with hospitals or cutting their own expenses — have a limited impact, said Standard & Poor’s analyst Deep Banerjee. He added that delving into care is the most efficient way for insurers to manage costs.
If insurers don’t find a better way to control costs, Amazon might. The online giant announced earlier this year that it will collaborate with billionaire Warren Buffett and JPMorgan Chase to create a company aimed at giving employees high-quality, affordable care. The companies have yet to announce details.
Insurers and other nontraditional care providers like CVS say they aren’t trying to replace doctors or randomly shave expenses.
They say the goal is to supplement the care a patient already receives or provide affordable options for people who don’t have doctors. Big acquisitions also help them gather more information about customers, which can improve care, for instance, by helping doctors figure out which medicine might work best for a patient.
They also say that cutting costs and improving care are not mutually exclusive goals.
Humana gives wireless scales to about 2,000 patients with congestive heart failure — a sliver of the insurer’s total enrollment — and has nurses monitor their weight remotely. A sudden gain can be a sign of looming trouble for these patients, so a nurse may check in to see if they need to adjust their prescription or see a doctor.
“If we can intercede before a heart attack, we not only obviously help the individual, but we prevent an ER visit and downstream cost of that,” CEO Bruce Broussard said earlier this year at a health care conference.
UnitedHealth Group runs the nation’s largest insurer, but its separate Optum business also operates more than 1,100 doctor offices, urgent care and surgery centers.
Optum leaders say their urgent centers can handle 90 percent of the care patients would receive in an emergency room at a fraction of the cost, thanks to lower overhead and fewer staff. Their surgery centers can perform outpatient procedures, which don’t involve an overnight stay, for about half of what a hospital charges and still deliver high quality care, they say.
“It’s about more care in the right setting,” Optum executive Andrew Hayek said, adding that his company works with more than 80 different health plans, not just UnitedHealth customers.
Insurers say the expansions will lead to more personalized, affordable health care. Whether the average patient sees lighter insurance or pharmacy bills remains to be seen.
Health care consultant Bob Laszewski expects insurers to be focused first on making sure their stockholders get a return from these big deals
“When you spend $50 billion of shareholder money, it’s clear the accountability is going to be with the shareholder not with the patient,” the former insurance executive said.
Lawmakers and doctors have long been concerned about corporate influences on medical care. Most states have laws or standards that prevent a business or employer from interfering with a doctor’s medical judgment, health care attorney Kim Harvey Looney said. But these standards don’t prevent an insurer from denying coverage if a treatment is deemed experimental or excluded under a plan.
That worries Caplan, an ethicist with New York University’s School of Medicine. He wonders how hard doctors will fight for patients if it means clashing with their own employers.
“It’s a little easier to be an advocate for the patient when you don’t work for the corporation that is controlling the reimbursement decision,” he said.
Another medical ethicist, Dr. Matt DeCamp of Johns Hopkins University, said he doesn’t see an inherent conflict of interest when insurers provide care.
Whether one surfaces depends on how the deals are structured. DeCamp would want to know how involved the patient’s regular doctor is with insurer programs that manage care and whether participation is linked to the cost of coverage. That could make it hard for patients to say no.
Ultimately, insurers can earn customer trust simply by keeping them healthy for a reasonable price, said health economist Paul Keckley. But that will be a struggle for an industry in which the average patient already has little faith, he said.
“You trust your nurses most, your doctors and pharmacists next, hospitals some, and insurers none,” he said.
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March 9, 2018
Impact Of Losing An Hour of Sleep
How can resetting your clocks do all that? TIME asked Dr. Cathy Goldstein, an assistant professor of neurology at the University of Michigan School of Medicine Sleep Disorders Center, what really happens to your body when you lose an hour of sleep for Daylight Saving Time.
Your circadian rhythm is thrown off
Daylight Saving Time’s true impact goes beyond losing an hour of sleep, Goldstein says. Your circadian rhythm, an internal clock that “exists so that wakefulness is promoted during the day, and sleep is promoted at night,” Goldstein says, is also affected.
Thanks to circadian rhythms, the body begins secreting melatonin, a sleep-promoting hormone, around 9 p.m., with levels dropping way off by the next morning. Light exposure can moderate your circadian rhythm a bit, but the body more or less relies on consistent sleep and wakefulness cues — so when they’re altered, even by an hour, your sleep gets misaligned.
“You take somebody who’s very sleepy when they get up at 6 a.m., and then they get up at 6 a.m. during Daylight Saving Time, and for them that’s physiologically 5 a.m.,” Goldstein says. “That’s a big problem, because you’re waking up at a time when the circadian system is not yet promoting alertness. It’s still pushing for that sleepiness.”
Plus, you may lose sleep on both ends of your cycle, since your normal bedtime will feel earlier, potentially making it harder to fall asleep in the first place. Even worse, DST happens on a weekend, when many people stay up later and sleep in. Because of the cumulative effects, you lose more like two or three hours of sleep, and it could take up to a week to get back on a normal schedule, Goldstein says.
Lost sleep directly affects your health
Research has shown that losing an hour of sleep may cause you to eat roughly 200 more calories the next day, primarily from fat- and carbohydrate-heavy foods. Exercise endurance also falters after a night of inadequate sleep, Goldstein says, so your workout will likely be sluggish. Work or school performance may also suffer, she adds, citing studies that have found an uptick in “cyberloafing” — or wasting time online — in the days after DST.
Many studies of shift workers, whose nighttime sleep is often disrupted, have also identified health problems associated with chronic sleep deprivation, including heightened risks of obesity, cardiovascular disease and even cancer. While one night of bad sleep certainly isn’t enough to cause these conditions, Goldstein says the findings highlight the importance of solid slumber.
Here’s how to minimize the impact
With a little planning, you can save yourself from the worst of the DST hangover.
Before the event occurs, Goldstein recommends going to bed and rising 15 minutes earlier than you normally would. Then, continue to shave off an additional 15 minutes each night leading up to the time change. That way, by the time Daylight Saving Time rolls around, you’ll be more or less acclimated to the adjusted time.
“To help you do that, I recommend getting lots of bright light in the early mornings, because that is what makes your internal clock earlier, and that will help you match better to Daylight Saving Time when the clock adjusts,” Goldstein says.
You should also use DST as inspiration to take stock of your regular sleep habits, Goldstein says. For example, most people could do a better job of keeping sleep and wake times consistent, even on weekends. (Goldstein recommends waking up at your normal time and taking a nap on weekend afternoons, if you need one.) Another common area for improvement is minimizing technology use within two hours of bedtime, Goldstein says.
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Lying Rehabs In Swamp California
From the Orange County Register by Teri Sporza People looking to quit alcohol or other drugs typically find treatment the same way they might search for take-out food or a mechanic – by typing search words into Google. Once there, addicts and their families can get trapped in a tangle of lies. The deception has taken many forms:
Brody Webster, 22, pops Zubsolv, a pill he dissolves beneath his tongue to curb his cravings for opioids. Medical-oriented treatment is rare in the drug and alcohol recovery business, though many ads for rehab centers imply otherwise. Health experts say deceptive advertising in the rehab industry is dangerously common. (Photo by Mindy Schauer, Orange County Register/SCNG)
— Competitors hijack online traffic from established centers by buying common misspellings and iterations of rehab names and key phrases.
— Rogue treatment centers create hundreds of blogs and websites hammering crucial keywords to take advantage of Search Engine Optimization, directing addicts to sites that promise far more than they actually deliver.
— Phone banks and boiler rooms have paid hundreds of dollars for choice Google AdWords, making their sites come up first in searches such as “drug treatment Los Angeles.”
“Google is the No. 1 referrer of addiction treatment in America – not health professionals,” said Greg Williams, executive vice president of the nonprofit Facing Addiction. “And with great power comes great responsibility.”
The prevalence of paid advertising in addiction treatment, which can bury unbiased health information from governments and nonprofits, translates to danger for vulnerable people desperately seeking help for an often fatal disease, critics say.
Jim Hood lost his oldest son Austin to addiction in 2012. (Courtesy of Jim Hood)“As I look back over my son Austin’s six-year battle with addiction, I am profoundly sad, and angry,” said Jim Hood, co-founder of Facing Addiction. “Sad that he spent one-third of his life suffering from this horrific illness, and unspeakably sad he lost his battle just days before his 21st birthday.
“Yet I am angry, too, because his journey was so incredibly difficult, uncharted, and altogether unnecessary,” Hood added.
“Austin sought help from 15 or more people or places. Most of the time, we felt like we were searching for a restaurant on Yelp.”
Google AdWords
The Beacon House is one of the granddaddies of addiction treatment in California — a nonprofit founded in 1959, situated in a grand Victorian estate on the scenic Monterey Peninsula.
If you searched Google for “Beacon House Monterey” just a few months ago, a list of ads for Beacon would have popped up. If you clicked through and called the contact number, you might have learned that the Beacon House in Monterey was, unfortunately, full. But you also would have been told that there were great spots for you in top-notch treatment centers in Orange County or Palm Springs or Florida.
Unbeknownst to prospective patients and their families — many often searching during a time of crisis — those calls for help were routed away from Beacon to boiler rooms staffed by marketers who paid big money for rehab-related Google AdWords.
Phone operators took down names, phone numbers, addresses, and insurance information — then sold that information to treatment centers for the highest bid. Centers often paid $1,000 to $10,000 for a insured potential clients, depending on the level of care needed, said Peter Brunzelle, owner of SALS sober homes in Wisconsin.
“You’re buying and selling human beings,” Brunzelle said.
Marketers could hijack the names of established rehabs, then sell prospective patients to other centers.
The patient brokers were making money.
So was Google.
Last year, before it filed for bankruptcy, the rehab center Solid Landings Behavioral Health, in Costa Mesa, was spending $33,452 a week on marketing, according to court documents. Its Google debt, dated last March, totaled nearly $49,000.
The treatment industry is so competitive that even the word “addiction” commanded big money in the online advertising world. “Keywords,” as Google calls them — including “addiction,” “treatment,” “rehab,” and “heroin,” among others — have commanded up to $90 per click on Google, advertising experts said. And key phrases — like “rehab Los Angeles” or “addiction treatment Orange County” — could reap hundreds of dollars per click-through for Google.
“Recovery,” “rehab” and “treatment” once ranked in the Top 20 most expensive words in the entire keyword universe, according to the online marketing firm WordStream.
“It was pretty wild,” said Nick Jaworski, owner of digital marketing firm Circle Social Inc., in Indianapolis.
“The way it was set up with Google wasn’t bad (in itself). It’s just these people were doing shady practices.”
Google grant that couldn’t
Last year, Facing Addiction, the nonprofit based in Connecticut, created the Addiction Resource Hub, “a comprehensive compendium for individuals looking for unbiased information,” which was built on Google technology.
In an attempt to help the little guys, Google provided grants to nonprofits like Facing Addiction. The idea was to help them acquire important — and competitive — keywords, but set a maximum bid of $2 per word.
The little guys couldn’t compete.
“The Google Keyword Planner suggests bids of $51.61 for ‘drug rehab,’ $70.14 for ‘alcohol rehab,’ and $63.60 for ‘alcohol treatment centers,’” said a report that Facing Addiction presented to Google.
“These suggested bids are well outside the allotted $2 …. Facing Addiction is effectively unable to use our AdWords grant because the process has been hijacked by unscrupulous players willing to pay astounding – but presumably profitable – amounts to buy ‘leads’ of people who are desperately seeking help,” the report added.
Pacific Solstice, an outpatient treatment center in Mission Viejo, tried AdWords for four months more than a year ago. It set up a Google pay-per-click account with a budget of $10,000 a month.
“We ended up spending $40,000 and we got nothing,” said Evan Fewsmith, the marriage and family therapist who owns Pacific Solstice. “Not a single client. We couldn’t compete.”
The only centers who could afford to play the game, Fewsmith said, were “the big warehousing rehabs.”
Facing Addiction told Google that the search engine’s role in “system navigation” was one of the most significant barriers to accessing quality health care options and independent information.
Google was moved by these arguments. In September, the company restricted ads for some rehab AdWords in the United States. Similar complaints raged in the United Kingdom and, earlier this year, Google banned rehab-related AdWords there as well.
“We’re banning keywords in several languages. We’ll decide whether to re-enter, but it will be a thoughtful approach,” said a spokesperson for Google. “Bad actors will find a way around anything.”
The American Society of Addiction Medicine and many others praised Google’s moves as a win for patients.
“We still have a long way to go to integrate addiction treatment into mainstream medical care so that doctors are the ones making treatment referrals,” said President Kelly Clark in a statement. “In the meantime, ASAM would be pleased to work with Google to help it identify high-quality treatment providers to advertise on its site.”
The rehab ad cutback, at least in the U.S., did not appear to hurt Google’s bottom line. Advertising revenue topped $95.37 billion in 2017, up from $79.38 billion in 2016 and $67.39 billion in 2015, according to documents filed with the Security and Exchange Commission by Google’s parent company, Alphabet.
Other tricks
But AdWords are only part of a larger problem, many say.
Hazelden Betty Ford, perhaps the oldest and best known addiction treatment provider in the nation, said competitors have bought various misspellings of its name so even errant traffic would be directed to their websites. Hazelden has devoted staff and built tools to regularly monitor misspellings — Hazelton, Hazelten and the like — to see where searches end up.
If would-be patients are redirected to a call center, or to another rehab center’s website, Hazelden Betty Ford makes direct contact and asks that the practice cease. Usually, the offenders express surprise and the behavior ceases, said Mark G. Mishek, president and CEO of Hazelden Betty Ford.
Mishek noted there are other ways to game.
Some centers know how to manipulate search results to make sure their properties land on top of each search. “I had one CEO brag to me, ‘Yeah, Mark, I have 104 websites. I have moms laying around in their pajamas writing articles for me, getting the right words in to get to the top of the heap on search,’” said Mishek. “It’s so crass. So manipulative.”
Typically, these websites purport to be informational, but are actually owned by companies trolling for insured addicts and steering people to their centers without disclosing who they are.
“If you have the biggest budget to spend on marketing, you can create a thousand websites,” said Williams of the nonprofit Facing Addiction. “That way it’s not government or nonprofit information people find when they search; it’s treatment center marketing disguised as factual information. They disguise who they really are.”
In the ideal world, Google would deploy some kind of punishment for this manipulation, Williams said.
Google officials said they are considering shutting down every ad search related to “addiction” and are trying to hammer down other abuses as well.
“We are always looking at ways to improve our enforcement and are working with industry experts to find a robust, long-term solution,” said a Google spokeswoman.
Beyond the tricks intended to lead addicts astray, addiction ads themselves — on a variety of media platforms — often are untrue.
Addiction-related ads on TV and the web are rife with men in crisp white lab coats with stethoscopes dangling from their necks, even from rehab centers that aren’t licensed to offer medical services.
Ad copy uses scientific language like “dual-diagnosis” and “evidence-based care,” defines addiction as a disease that alters brain structure and functioning, and describes the physical risks of withdrawal in sometimes-disturbing detail. They say that recovery requires “a supervised environment where people can receive medical care to ensure their safety,” giving the impression of medical competence even at centers run by contractors or entrepreneurs with little or no medical background.
“They promote that they have everything under the sun, but they can’t deliver,” Mishek said. “Some of the things we’re seeing really make me cringe.”
Personal testimonials — perhaps the oldest form of advertising and common in the world of rehab marketing — are among the most disturbing, Mishek said.
Hazelden Betty Ford uses testimonials, too, though Mishek said its ambassadors have years of sobriety before cameras are trained upon them. Other centers often require less.
“I’ve seen ads where the guy has been sober for maybe three months,” Mishek said. “That is really awful. That sets this man up for spectacular relapse.”
New laws
Florida has a dense concentration of rehab centers and related fraud, much like California, but legislators there have taken steps to regulate rehab advertising.
Last year, Florida adopted a law that prohibits rehab-related entities from engaging in deceptive marketing and provides criminal penalties for violations. The law also touches online ads specifically, making it a felony to write coding that surreptitiously directs the reader to another website.
Could similar laws be passed in California?
“It’s certainly something we can explore,” said Sen. Richard Roth, D-Riverside, after a Senate Health Committee hearing on how rehab regulation works in California. “The procurement of clients, or patients, was concerning to most of my colleagues on the dais.”
Sen. Pat Bates and Rep. Sharon Quirk-Silva and others have introduced bills aiming at cleaning up the industry. But some say new laws aren’t necessary to address deceptive advertising.
“There are plenty of laws on the books right now, and if you had a crusading Attorney General or District Attorney could use existing law to shut them down,” said Hazelden Betty Ford’s Mishek, who is also a lawyer. “If someone like a state Attorney General were to do it, you’d get reform.”
As Google leads are drying up, some treatment centers are turning to Facebook to recruit new clients, advertising executives say.
Facebook allows advertisers to target niche markets, filtering ads by age, income, location, gender and more.
“The real power is in tailored re-targeting,” the digital marketing firm Social Circle wrote in a Digital Journal post pitching its services. “Unlike Google AdWords, Facebook has the power to choose exactly who you’re targeting…. From there, you can re-target Facebook users based on if they’ve visited your website, watched one of your videos, interacted with your ad, or liked your page.
“Once someone is on the phone,” the post added, “they are already committed to a specific center.”
These advertisements can also be much cheaper than Google: A Facebook ad can cost 31 cents to 61 cents per click, according to fitsmallbusiness.com.
It’s life or death
Williams, whose work helped convince Google to ban rehab-related AdWords, praised Google’s move, but noted that it was incremental. Google, he suggested, needs to treat addiction like the potentially lethal disease it is.
The analogy he and others point to is depression.
When you use Google to search the phrase “I want to kill myself” you don’t get a long list of for-profit therapists eager for your business; you get the toll-free number for the National Suicide Prevention Lifeline bannered across your screen.
But if you type “I need addiction treatment” into the Google search bar, you’ll get a map with little red pins representing treatment centers. All of those centers paid to be there. Free information about addiction — from the government, nonprofits and medical experts — is buried.
“We need bold action. When people search ‘how to stop doing drugs’ or ‘how to find addiction treatment,’ Google could interrupt its traditional algorithms and return validated, evidence-based information, just like they do with suicide prevention,” Williams said.
“They have the power to do that. They would save lives overnight.”
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March 8, 2018
Groundbreaking Study Finds SMART Recovery Yields Smart Results
From Gary Enos @ Addiction Professional: Individuals who seek strong recovery support but don’t see themselves as a fit in 12-Step meetings will likely be heartened by results of the first longitudinal study comparing 12-Step groups with three secular alternatives. The study concluded that active involvement in mutual-help groups produces equivalent benefits in substance use outcomes, regardless of which group the recovering individual chooses.
The study’s lead author emphasizes that the results of a single study should not be over-interpreted. But the co-founder of the most prominent alternative support organization in the U.S. cannot hide his strong enthusiasm for the data that are now published in the Journal of Substance Abuse Treatment.
“If you’re in SMART Recovery, this is about as big a week as it gets,” A. Thomas Horvath, PhD, who is also president of the Practical Recovery treatment facility in Southern California, tells Addiction Professional.
Those who have sought to grow organizations that offer recovering individuals an alternative to Alcoholics Anonymous (AA) and its derivatives believe these findings will give an important boost to a secular recovery support component that has gone under-researched—and that, in some circles, has been marginalized.
Horvath describes the perceptual shift that he thinks this research will bring about. “Rather than presuming that AA is the best until somebody proves otherwise, the presumption should be that all groups are equal until proven otherwise,” he says.
Format, Results Of Study
The Peer Alternatives in Addiction study comprised three waves of data collection (baseline, 6-month follow-up and 12-month follow-up), comparing alcohol and drug use outcomes among participants in 12-Step groups, SMART Recovery, Women for Sobriety and LifeRing Secular Recovery.
To be included in the study, individuals had to confirm attendance at one of the support groups in the past 30 days. Participants from the secular support organizations were recruited with help from the executives of the three organizations, while 12-Step attendees were recruited via advertisements posted on the online meeting hub In the Rooms.
Study participants were asked to report their overall meeting attendance in the past 30 days and to state if they had a primary/regular group, if they had a sponsor or close friend that they could rely on in their group, if they had led/facilitated a group meeting, and if they had done servce or volunteer work at a meeting. These variables were used to measure recovery group affiliation and recovery group involvement.
Participants also were asked at each stage of the study to state their overall recovery goal from among five options, along a spectrum ranging from total lifetime abstinence at one end to controlled substance use at the other.
The preliminary analysis found that having an alcohol goal of lifetime abstinence and having higher primary group involvement at baseline were associated with better outcomes. It also found that those who identified SMART Recovery as their primary group had lower odds of both alcohol abstinence and no alcohol problems at 12 months.
However, when the researchers adjusted for all possible confounding factors, it was discovered that this difference for SMART Recovery was based on the fact that fewer SMART Recovery members had articulated total abstinence as their primary goal. The multivariate analysis concluded that there was no difference in efficacy between the secular alternatives and the 12-Step groups.
In essence, what the researchers utlimately found was that active involvement in a support group, not any particular component of the particular group’s content, was what conferred the benefits to the participant.
Study lead author Sarah E. Zemore, PhD, senior scientist and director of training at the Alcohol Research Group, tells Addiction Professional that a substantial body of research has demonstrated large effect sizes for AA. But because other research has shown that comparatively few people who complete formal treatment end up sticking with AA over the long term for support, it is important to examine the efficacy of alternatives to 12-Step.
“When you go to public treatment, you’re getting AA,” says Zemore. “But at the same time, there should be more options.”
Another noteworthy finding in this research is that of higher participant satisfaction and cohesion in the alternative groups compared to 12 Step. Zemore speculates that this could stem from the fact that some 12-Step participants had no other viable options for recovery support. It is also possible that some were mandated to attend 12-Step meetings, as often can be the case for justice-involved individuals.
New Frontiers
Zemore says she will be seeking funding for additional research into alternatives to 12-Step support. She would like to examine the mechanisms of action in groups such as SMART, Women for Sobriety and LifeRing. “We really don’t know why these alternatives work,” she says.
Ultimately, a randomized trial comparing the support groups would be ideal, she indicates. It also would be important to determine whether facilitating choice among groups would represent a sound strategy for improving recovery outcomes.
You have choices in recovery. Visit Recovery Guidance to find therapists, recovery centers, and peer group meetings near you.
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8 Traits Of Functional Families
According to family experts Friel and Friel, authors of Adult Children, The Secrets of Dysfunctional Families, healthy functional families have eight traits in common. See where your family fits.
1. Functional Families Meet Basic Needs
Functional families are consistently meeting each individual’s most basic needs for food, shelter, and clothing. A family that is food insecure, shelter insecure, or without the basic clothing needed, is vulnerable is every way. Growth is almost impossible when survival itself is the everyday focus.
2. Members Are Safe
Beyond food and clothing, safety is a fundamental need for every family member. Being safe from emotional and physical abuse is critical. Family members embrace and nurture each other. They thrive.
3. Family Members Are Loved
Noted psychologist Abraham Maslow explains that we also have a deep need for love and belongingness. For an individual and family to grow, they need to know that they are loved, cherished, and belong to their tribal family. Here the family works as a unit to allow each member to talk about issues, to trust others, and to feel their feelings.
4. Each Person Is Encouraged To Be Unique And Independent
There is a strong need for autonomy or separateness. Functional families allow each individual in the family to grow and develop. Also called individualization, each person in a functional family becomes a unique self and the family supports this ongoing development. The individual is seen as their own person while still functioning as part of this healthy family system. In this manner, the family also embraces diversity.
5. All Members Are Worthy And Valuable
Families also function to promote self-esteem or a sense of worth in each family member. Each person is seen as worthy and valuable to the family. Family members praise each other. This is about dignity and self-assurance of each individual.
6. Everyone Gets To Make Mistakes
Perfectionism is not a goal for it is unhealthy, and each member and the family itself must make mistakes in order to learn, heal, and grow. Here we realize that we are all imperfect beings in our perfection of our selves. Without making mistakes, no one would be able to cope within this imperfect, perfect world.
7. Functional Families Have Fun
Play is a very important aspect of healthy development; without it, our growth becomes static, rigid, and perfectionistic. Play also includes exploring the many outlets of creativity. Each family member and each family needs allow creativity such as:
Playing
Writing or journaling
Singing (even if you can’t carry a tune)
Playing sports or doing yoga
Do whatever it is that makes your heart soar.
8. Families Have Spirituality, Too
That old adage about families that pray together has some merit. In spirituality, the family embraces a sense of wonder and awe, of creation and creativity, of joy and sorrow, and of love and gratitude. The family sets the basis of spirituality and allows diversity of belief and practices for each individual.
So, how does your family measure up? Don’t be in a panic if you don’t meet all of these functions. For remember, the family, and each individual, needs to make mistakes in order to develop throughout the lifespan. Are there ways that the family can improve? How can your entire family explore these traits and focus on healing?
Therapy can help you get back on a healthy path. Find counselors near you at Recovery Guidance.
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International Women’s Day 2018: Beyond #MeToo, With Pride, Protests, And Pressure
From Elisabetta Povoledo, Raphael Minder and Choe Sang-Hun @ The New York Times: In the era of #MeToo and Time’s Up, International Women’s Day arrived on Thursday with a sense of urgency and determination.
For many women, there was a keen awareness that there had been a major shift in the firmament when it came to gender parity, the treatment of women in the workplace and sexual dynamics.
But others — scratching out lives in developing countries in Africa, toiling away at jobs with little pay in Latin America or scrambling to raise children without help in the Middle East — most likely had little time left over to reflect on the one day of the year designated to celebrate “the social, economic, cultural and political achievements of women,” as the website says.
Nonetheless, Margrethe Vestager, the European competition commissioner, said on Twitter: “There is a lot to fight for: Engage! Women and men alike. We need power to make equality a reality.”
A demonstration for women’s rights in Bilbao, Spain. Credit Vincent West/Reuters Some women, fueled by impatience over the long-running fight for equality and the sense that the glacial pace of change would just not do, found large and small ways to protest — with pots and pans, raised fists and howls of rage.
A ‘Domestic Strike’ And A Discount
To highlight gender inequality, feminist groups in Spain asked women to spend no money and to ignore chores for the day — to go on a “domestic” strike.
The actress and mother Penélope Cruz said she was on board. Joining several left-wing politicians, two prominent members of Spain’s governing conservative party, Agriculture Minister Isabel García Tejerina and Cristina Cifuentes, the head of the regional government in Madrid, announced that they would observe a day of work-to-rule, in which one works exactly the hours assigned and no more.
The newspaper El País posted a video explaining why it was not fully staffed: The women were away.
Hundreds of women gathered at midnight in Puerta del Sol, in the heart of Madrid, to kick off a day of protests across the country, with about 120 street demonstrations scheduled later on Thursday. Women banged pots and pans and shouted slogans during the protest.
A Palestinian schoolgirl during a school trip to mark Women’s Day in Gaza City. Credit Mohammed Abed/Agence France-Presse — Getty Images
The mobilization in Spain had the backing of most trade unions. Ten unions called for a 24-hour strike, while others called for two-hour work stoppages. Service on Madrid’s metro system was significantly disrupted after the Transport Ministry announced that 300 trains would not be operating. Renfe, the national railways company, canceled more than 100 long-distance trains because of the strike.
The women’s strike was covered extensively on Spain’s morning television and radio shows, but not by the country’s most famous female presenters, who stayed away from work.
“If women stop, it has to be noticed,” Ana Rosa Quintana, a TV presenter, wrote on Twitter.
The issue also generated some political controversy. The regional Parliament of Valencia was split on Thursday, as right-leaning female lawmakers took part in a session while their left-wing counterparts left the assembly and hung signs on their chairs that read, “I’m stopping.”
The leader in Valencia of the conservative Popular Party, Isabel Bonig, argued that striking lawmakers ridiculed the sacrifice made by other women because they could leave the parliamentary session for a few hours without suffering any financial consequences — unlike other women in other professions.
Band members of the Armed Police Force at a rally for International Women’s Day in Kathmandu, Nepal. Credit Navesh Chitrakar/Reuters
Data from the European Union’s statistical provider Eurostat show that women in Spain were paid 13 percent less in the public sector and 19 percent less in the private sector than their male counterparts. In 2016, women’s gross hourly earnings in the European Union were on average 16.2 percent below those of men.
The call for a strike went out in England, too, where it was organized on social media by a group called the Women’s Strike Assembly UK: “Today #WeStrike! Wear red, bring an umbrella & join us.” And in France, where the gender pay gap is 25 percent, according to one paper, Libération, Thursday’s edition was sold with two prices: 2 euros for women, and €2.50 for men.
The Libération daily newspaper in France gave women a special discount for Thursday’s edition. Credit Stephane De Sakutin/Agence France-Presse — Getty Images
In Italy, marches were held in dozens of cities and women were also encouraged to strike. The Italian post office issued four stamps dedicated to the “Italian female genius.” Countless mimosa tree branches were felled so that women could receive gifts of small bouquets of the odorous yellow flowers.
Representatives of a project called 100 Women against Stereotypes met in Rome to promote an online platform that sponsors female experts in a variety of areas.
A memorial in Ciudad Juárez, Mexico, for women who were violently killed. Credit Jose Luis Gonzalez/Reuters
And after being held inside Vatican City for years, the Voices of Faith conference, which champions women’s leadership in the global Catholic community, moved to the headquarters of the Jesuit order. The venue was moved after the Vatican expressed disapproval of the choice of three speakers on the schedule, including a former president of Ireland, Mary McAleese, who has championed women’s ordination.
As thousands of students marched in Milan on Thursday morning, one group broke off to chant slogans in front of a hospital, protesting the majority of Italian doctors who refuse to perform abortions, even though it is legal.
In Rome, the actress Asia Argento, who has received criticism in Italy for accusing Harvey Weinstein of sexual assault, was among the women who marched.
Defying Duterte In Manila
Hundreds of activists sang and danced in a boisterous rally in Plaza Miranda, in central Manila, while handing red and white roses to the mothers, sisters and widows of those suspected of drug offenses who have been slain under Mr. Duterte’s brutal crackdown.
The protesters noted the thousands of people they say have died in extrajudicial killings — accusations the police have denied. One protest leader, Jean Enriquez, condemned Mr. Duterte’s remarks against women, including one in which he asked troops to shoot female communist rebels in the genitals.
“We’re so alarmed,” she said, according to The Associated Press. “We have seen his direct attacks on women under his iron-hand rule, and it’s now time to heighten our resistance.”
In India, where the gang rape of women and sexual assaults on young girls have brought anguish and soul searching, students, teachers and workers in the sex industry marched toward Parliament, demanding their rights and action against domestic violence, sexual attacks and discrimination in jobs and wages.
A demonstration in New Delhi on Thursday. Credit Rajat Gupta/European Pressphoto Agency
“Unite against violence against women,” one placard read. “Man enough to say no to domestic abuse,” said another. “My body, My choice.”
In China, The Forever Boyfriend
Students at Tsinghua University celebrated International Women’s Day with banners making light of a proposed constitutional amendment to scrap term limits and allow President Xi Jinping to stay in power indefinitely, according to news reports.
One banner said that a boyfriend’s term should also have no limits, while another said, “A country cannot exist without a Constitution, as we cannot exist without you!”
Photographs of the banners were shared on Chinese social media before, according to online commenters, the posters were swiftly removed — most likely by censors.
A woman taking part in a taekwondo ceremony in Nairobi, Kenya. Credit Yasuyoshi Chiba/Agence France-Presse — Getty Images
‘A Revolution Afoot’ In South Korea
More than 500 women’s rights leaders gathered in Seoul on Thursday, vowing to keep up a #MeToo campaign that has gained steam in South Korea in recent weeks. Political leaders raced to join them to voice their support ahead of elections scheduled for June to select mayors and provincial governors.
In central Seoul, feminist activists handed out white roses as a symbol of support for the movement. Nearby, hundreds of labor activists rallied and waved #MeToo signs.
Another group of female workers held a rally holding signs that said, “Stop at 3 p.m.” The wage gap between men and women was so wide in South Korea that women should stop working at that time to break even, they said.
The Korean Women’s Associations United called for reform in the country’s “patriarchal social structure that breeds gender discrimination.”
The words “Now We Act” were projected on the Eiffel Tower on the eve of International Women’s Day. Credit Francois Mori/Associated Press
“We see a revolution afoot,” it said. “And the leader of this revolution is women.”
Marching, Despite The Taliban
When the Taliban ruled parts of Afghanistan, many women were too afraid to leave their homes. But on Thursday, hundreds marched in Kabul, the capital, to remind their leaders that much work needed to be done to give Afghan woman a voice, ensure their education and protect them from often brutal violence and an oppressive patriarchic system.
The head of the Independent Human Rights Commission, Sima Samar, speaking about women in the country’s security forces, declared, “Your safety represents the safety of all Afghan women.”
But that great work still needed to be done is clear. A report released on Thursday by the Economic Policy Institute showed that when it came to wages, American women with graduate degrees made less money than men with only college degrees. In a cradle of gender equality, Denmark, women spent far more time than male partners on household chores, according to a study by the Danish Employers’ Association for the Financial Sector.
A report unveiled on Thursday by Open Society Foundations in Brussels and titled “An End to Manels,” or all-male panels, showed that female speakers are outnumbered by men by three to one at Europe’s top 23 international policy events — including the Davos conference and the Munich Security Conference.
Christal Morehouse, the report’s author, said in a statement, “The policies being debated affect women and men equally — it’s perplexing that in 2018 women still don’t have an equal opportunity to shape them.”
And in Central African Republic, women are still fighting for their daughters to get a good education and to start their own businesses in a country with the world’s second-highest rate of child marriage.
Recovery is all about empowering everyone. Sometimes, this takes a therapist or counselor’s help. To find a counselor near you, visit Recovery Guidance.
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March 7, 2018
Feeling anxious? Blame the size of your waistline!
From Science Daily Anxiety is one of the most common mental health disorders, and it’s more likely to affect women, especially middle-aged women. Although anxiety can be caused by many factors, a new study suggests that the amount of abdominal fat a woman has could increase her chances of developing anxiety. Study results are published online today in Menopause, the journal of The North American Menopause Society (NAMS).
Everyone is familiar with the term “stress eating” that, among other things, can lead to a thicker waistline. In this study that analyzed data from more than 5,580 middle-aged Latin American women (mean age, 49.7 years), the cause-and-effect relationship was flipped to determine whether greater abdominal fat (defined as waist-to-height ratio in this instance) could increase a woman’s chances of developing anxiety. Although this is not the first time this relationship has been examined, this study is the first of its kind known to use waist-to-height ratio as the specific link to anxiety. Waist-to-height ratio has been shown to be the indicator that best assesses cardiometabolic risk. A general guideline is that a woman is considered obese if her waist measures more than half of her height.
The article “Association between waist-to-height ratio and anxiety in middle-aged women: a secondary analysis of a cross-sectional multicenter Latin American study” reports that 58% of the study population were postmenopausal, and 61.3% reported experiencing anxiety. The study found that those women in the middle and upper thirds of waist-to-height ratios were significantly more likely to have anxiety, and those in the upper third were more likely to actually display signs of anxiety compared with women in the lower two-thirds.
Anxiety is a concern because it is linked to heart disease, diabetes, thyroid problems, respiratory disorders, and drug abuse, among other documented medical problems. Research has shown an increase in the frequency of anxiety in women during midlife, likely as a result of decreased levels of estrogen, which has a neuroprotective role.
“Hormone changes may be involved in the development of both anxiety and abdominal obesity because of their roles in the brain as well as in fat distribution. This study provides valuable insights for healthcare providers treating middle-aged women, because it implies that waist-to-height ratio could be a good marker for evaluating patients for anxiety,” says Dr. JoAnn Pinkerton, NAMS executive director.
Story Source:
Materials provided by The North American Menopause Society (NAMS).
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We’re not addicted to smartphones, we’re addicted to social interaction
From Science DailyA new study of dysfunctional use of smart technology finds that the most addictive smartphone functions all share a common theme: they tap into the human desire to connect with other people. The findings, published in Frontiers in Psychology, suggest that smartphone addiction could be hyper-social, not anti-social.
“There is a lot of panic surrounding this topic,” says Professor Samuel Veissière, from the Department of Psychiatry at McGill University, Canada. “We’re trying to offer some good news and show that it is our desire for human interaction that is addictive — and there are fairly simple solutions to deal with this.”
We all know people who, seemingly incapable of living without the bright screen of their phone for more than a few minutes, are constantly texting and checking out what friends are up to on social media.
These are examples of what many consider to be the antisocial behavior brought on by smartphone addiction, a phenomenon that has garnered media attention in the past few months and led investors and consumers to demand that tech giants address this problem.
But what if we were looking at things the wrong way? Could smartphone addiction be hyper-social, not anti-social?
Professor Veissière, a cognitive anthropologist who studies the evolution of cognition and culture, explains that the desire to watch and monitor others — but also to be seen and monitored by others — runs deep in our evolutionary past. Humans evolved to be a uniquely social species and require constant input from others to seek a guide for culturally appropriate behavior. This is also a way for them to find meaning, goals, and a sense of identity.
Together with Moriah Stendel, also from McGill’s Department of Psychiatry, Professor Veissière reviewed current literature on dysfunctional use of smart technology through an evolutionary lens. The researchers found that the most addictive smartphone functions all shared a common theme: they tap into the human desire to connect with other people.
Healthy urges can become unhealthy addictions
While smartphones harness a normal and healthy need for sociality, Professor Veissière agrees that the pace and scale of hyper-connectivity pushes the brain’s reward system to run on overdrive, which can lead to unhealthy addictions.
“In post-industrial environments where foods are abundant and readily available, our cravings for fat and sugar sculpted by distant evolutionary pressures can easily go into insatiable overdrive and lead to obesity, diabetes, and heart disease (…) the pro-social needs and rewards [of smartphone use as a means to connect] can similarly be hijacked to produce a manic theatre of hyper-social monitoring,” the authors write in their paper.
Turning off push notifications and setting up appropriate times to check your phone can go a long way to regain control over smartphone addiction. Research suggests that workplace policies “that prohibit evening and weekend emails” are also important.
“Rather than start regulating the tech companies or the use of these devices, we need to start having a conversation about the appropriate way to use smartphones,” concludes Professor Veissière. “Parents and teachers need to be made aware of how important this is.”
Story Source:
Materials provided by Frontiers. Note: Content may be edited for style and length.
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LGBT Youth Twice As Likely To Develop Eating Disorders
From Gary Enos @ Addiction Professional: Because health concerns in the LGBT population generally are considered to be an under-researched topic, the release of any comprehensive data in this area rarely escapes notice in the professional community. In the case of results of a newly released survey on eating disorders among LGBT young people, however, these fresh numbers are both noteworthy and utterly staggering.
Cosponsored by the National Eating Disorders Association and unveiled as part of the annual awareness week activities that it spearheads in February, the survey of more than 1,000 young people ages 13 to 24 found that more than half (54%) had received an eating disorder diagnosis at some point in their young life. Moreover, of those individuals who had not received this diagnosis, 54% said they suspected they had an undiagnosed eating disorder.
Such numbers did not appear to surprise Philip McCabe, a health educator at the Rutgers University School of Public Health and president of NALGAP, The Association of Lesbian, Gay, Bisexual, Transgender Addiction Professionals and Their Allies. However, McCabe tells Addiction Professional, “As a trainer on LGBT issues I find many clinicians are surprised when I share information on eating disorders with gay and bisexual youth.”
McCabe adds, “This raises several areas of concern—first, not all addiction professionals have received training on eating disorders. Unless the client self-discloses, it is not always included during the assessment.”
What The Numbers Show
The online survey also was conducted by Reasons Eating Disorder Center and The Trevor Project, the latter being an organization seeking to end suicide in the LGBT population. It took place from early January to early February and included individuals identifying as a sexual orientation other than heterosexual and/or a gender identity other than cisgender, which is defined as identifying with one’s gender of birth. A detailed questionnaire explored disordered eating diagnoses and behaviors, as well as any history of suicidal ideation or behavior.
The survey found that transgender youth face a disproportionate risk of having an eating disorder, with 71% of transgender respondents who identify as straight having been diagnosed with an eating disorder. However, cisgender LGBTQ females (the Q stands for both queer and questioning in the survey) reported the highest prevalence of eating disorder diagnoses of any gender identity in the survey, at 54%. By comparison, the prevalence of eating disorders among cisgender males was 31%, and the prevalence of eating disorders among transgender females was 12%. A total of 39% of transgender males reported an eating disorder diagnosis.
The researchers reported that across all subpopulations in the survey, the most common habits of disordered eating were fasting, skipping meals and eating minimal amounts. Bulimia was the most common eating disorder diagnosis that cisgender and transgender females had received.
The survey also illustrated a close link between the presence of an eating disorder and suicidality. Responses indicated that 58% of LGBTQ youths who had been diagnosed with an eating disorder have considered suicide. Suicidal thoughts were more common among young people who had been diagnosed with bulimia, the researchers reported.
An introduction to the survey document from Amit Paley, CEO of The Trevor Project, states that the findings “are alarming and highlight the need for further research to improve the lives of LGBTQ young people in this country.”
Correlations Go Unrecognized
“There is a correlation between body dysphoria, poor body image, combined with how individuals who experienced trauma and minority stress, that is not always understood,” says McCabe in reaction to these findings on eating disorders in the young LGBTQ population. He adds, “This survey helps to shed light on the greater health risks of LGBTQ youth and young adults.”
Paley adds in the survey document, “The unique stressors that LGBTQ-identified people experience, such as coming out and harassment in schools or the workplace, can impact levels of anxiety, depression, low self-esteem, and unhealthy coping mechanisms such as substance abuse. All of these can be contributing factors in the development of an eating disorder and are common co-occurring conditions.”
McCabe says that in discussing findings such as these, he often calls attention to a 2014 American Academy of Pediatrics study showing that gay and bisexual teen males use illicit steroids at a rate almost six times higher than straight teens.
McCabe suggests that clinicians who work with LGBTQ patients don’t always grasp the full range of behavioral health issues that can be related to the experience of minority stress in this population. “Knowing how to address the concerns with LGBTQ affirmative and comprehensive evidence-based interventions requires specific training,” he says.
Recovery Guidance lists counselors, therapists, and treatment centers which specialize in helping LGBTQ patients and eating disorders. Search today to find choices near you.
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Being a Sober Parent in a Wine Mom Culture
From Liv Tray @ The New York Times: Over a melting ice cream sundae on our first date away from our new son, my partner and I talked about what we’d be doing if we were still drinking. A cozy-looking bar across the street might have suited our purposes. Yet years of partying had shown us that abstinence was necessary for him and best for me. So, ice cream it was.
Popular parenting culture doesn’t have much room for sober sorts like us. Jokey messages on coffee mugs and T-shirts reinforce the notion that the best cure for the demands of our children is a generous glass of chardonnay. Parents who don’t drink are not offered such a simple solution to stress.
Dr. Leena Mittal, a perinatal psychiatrist and addiction specialist at Brigham and Women’s Hospital in Boston, said there is a long history of chemical management of women’s distress. Tranquilizers widely prescribed to mothers in the 1950s and ’60s were known as Mother’s Little Helper. “This sends women the message that their emotions need to be squelched and not addressed,” she said.
As the opioid crisis draws attention to the impact of addiction on families, there may be a new openness to sober parenting. More children are entering the foster care system because of the opioid epidemic. The National Survey on Drug Use and Health found that between 2009-14, approximately 10 percent of American children lived in homes where at least one parent had an alcohol use disorder. Dr. Mittal said women with the disorder often do not get treatment for their addiction because they fear losing custody of their children. Policy changes can encourage more women to seek help. The Family First Prevention Services Act, signed into law on February 8, 2018, provides substance abuse prevention and treatment services to parents whose children are at risk for being removed from their homes. Though data shows parents tend to drink less than nonparents, social context affects how much they consume.
“Wine has become normalized, expected and then reinforced by popular culture, social media, advertising,” said Gabrielle Glaser, author of “Her Best Kept Secret: Why Women Drink — and How They Can Regain Control.” She said that images of other people’s seemingly perfect children on social media heighten many parents’ feelings of inadequacy. “Whether they’re a celebrity’s child or it’s just somebody on your Instagram feed,” she said, “You think, what’s wrong with me?” The added stress contributes to more drinking, she said.
“Mommy wine culture is just another way some moms are coping with the pressures of parenthood — alone and without much social support beyond acknowledging that parenting is hard,” said a mother who asked to be identified as Amina S. because she participates in a 12-step program that calls for anonymity.
She is a 43-year-old creative development manager from Northern Virginia who stopped drinking in 2002. “Drinking as a default makes it difficult to develop other — not instant — coping skills,” she said. She manages the stress of raising her 6-year-old son by going to 12-step meetings and prioritizing downtime.
She said she takes walks or baths, hires a babysitter so she can read and schedules date nights. At book club meetings or dinners, where alcohol is often part of the picture, she never makes excuses for not drinking.
“Always have a beverage in your hand,” she advised. “Often, beverage pushers are just concerned about being a good host.” The main way to enjoy being sober at a party where people are imbibing is to know when to leave — before virtual strangers start sloppily declaring their love for you. As far as feeling out new friends, she said, “If someone invites me to a wine tasting, I’ll invite them to coffee. If they’re not interested in hanging out without alcohol, then that answers that.”
Jody Allard, 39, a mother of seven who does not drink, said that sober parents need to be more creative with stress management. Ms. Allard, managing editor of Seattle parenting magazine ParentMap, said one of her children has autism and has frequent meltdowns. “Recently, she and I got trapped on a bridge behind an accident and she screamed for an hour and a half,” Ms. Allard said. “That night, I took a long bath and read a book. These aren’t sexy methods of self-care, and they don’t offer the same degree of relaxation as a bottle of wine, but they don’t come with the same risks either.”
My vice is PBS murder mysteries. I also take antidepressants, do talk therapy, write and splurge on some indulgences at the grocery store.
Ms. Glaser suggests sober parents find an alternative group or subculture like bird-watching, yoga or pickup sports. If you just need something in your hand at the end of the day, she suggests popping open a seltzer and putting it in a nice glass to make it feel more special.
Dr. Mittal recommended that parents who want to drink less ask themselves what need the alcohol is serving and how to address it in other ways. If it’s treating their depression or anxiety, she advised they seek professional help. Treatments can include medication, psychotherapy and peer support groups. To reduce stress, she also suggested meditation, acupuncture or acupressure, as well as attending to common self-care steps like exercise, nutrition, staying hydrated and simply getting a good night’s sleep.
Want to quit drinking but need help? Recovery Guidance lists treatment centers, support groups, and addiction physicians near you.
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