Signs You’re Drinking Too Much 

According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), “drinking becomes too much when it causes or elevates the risk of alcohol-related problems or complicates the management of other health problems.” And although the Dietary Guidelines for Americans states moderate alcohol consumption is defined as up to one drink per day for women and up to two drinks per day for men, there’s no specific amount of alcohol or frequency of drinking that determines “too much.” 

With all of this haziness, how do you know if your relationship with alcohol is unhealthy? The clues are not the same for all people, but there are some common signs: 

• Others make comments about how much you drink 
• You get defensive about how much you drink
• You set limits but never meet them
• You spend time thinking about alcohol, craving it
• Alcohol is taking a toll on your health
• You use alcohol as a coping mechanism when dealing with negative emotions
• You frequently wake up with a hangover and/or you don’t remember what happened when you were drinking
• Alcohol is always the center of social events 
• Without alcohol, life seems less colorful and joyful
• You’re personally concerned about your own drinking habits

Monitoring your intake can help you stop before you go too far, but even then you could be dealing with a bigger issue, like substance use disorder, and it’s important to identify the root of the cause. 

“The difference between overuse and substance use disorder has to do with individual intentions or motivations,” said Cynthia Catchings, a psychotherapist and peer consultant with Talkspace. “Typically, drug/alcohol use can be occasional. It can even be a one-time experience. Overuse refers to frequent use and in quantities or amounts that are seen as more harmful.”

It’s a fine line, and it gets finer. According to Catchings, the difference between substance abuse and addiction is also minor. Substance abuse means using an illegal substance or using a legal substance in the wrong way. Addiction typically starts with abuse or using gateway drugs. You can abuse alcohol or any drug without having an addiction.

Do I Need Support for My Drinking?

If you recognize yourself in this list of clues above, you may be drinking too much, but that doesn’t mean you have an addiction or substance use disorder. 

The DSM 5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition — the latest version of the American Psychiatric Association’s compilation of the names, symptoms and diagnostic features of every recognized mental illness—including addictions), specifies the criteria for substance use disorders includes:

1. Taking the substance in larger amounts or for longer than you’re meant to.
2. Wanting to cut down or stop using the substance but not managing to.
3. Spending a lot of time getting, using, or recovering from use of the substance.
4. Cravings and urges to use the substance.
5. Not managing to do what you should at work, home, or school because of substance use.
6. Continuing to use, even when it causes problems in relationships.
7. Giving up important social, occupational, or recreational activities because of substance use.
8. Using substances again and again, even when it puts you in danger.
9. Continuing to use, even when you know you have a physical or psychological problem that could have been caused or made worse by the substance.
10. Needing more of the substance to get the effect you want (tolerance).
11. Development of withdrawal symptoms, which can be relieved by taking more of the substance.

No matter how minor a drinking problem may seem, and even if signs do not fit neatly into a category, alcohol abuse symptoms should not be ignored. If you are unsure where to start, there are several screening tools that help with determining whether someone has an unhealthy relationship with alcohol. For example, the CAGE (acronym) is a 4-item questionnaire that can indicate potential problems with alcohol abuse.

Please answer yes or no to the following questions:

1. Have you ever felt you should cut down on your drinking?
2. Have people annoyed you by criticizing your drinking?
3. Have you ever felt bad or guilty about your drinking?
4. Have you ever felt you needed a drink first thing in the morning (eye-opener) to steady your nerves or to get rid of a hangover?

If you answer “yes” to two or more CAGE questions, you should seek professional medical assistance.

Where to Get Help for a Substance Use Disorder

Alcohol causes changes in your brain that make it hard to stop drinking or find a different path forward. Trying to tough it out on your own can be very difficult, and it’s often not enough. If you’re experiencing difficulty coping or having problems with drug or alcohol use, you should get in touch with a healthcare professional or the Substance Abuse and Mental Services Administration (SAMHSA) hotline at 1-800-662-HELP (4357). They can refer you to local treatment facilities, support groups and community-based organizations.

Though the path ahead may be difficult, getting help is important, and it is essential to know that there are many effective treatments that allow people who are addicted to drugs or alcohol or experiencing substance use disorder to live healthy and fulfilling lives. The most effective treatment usually combines more than one modality and may include hospitalization, outpatient programs, self-help groups, and individual therapy. Talkspace offers affordable, online therapy wherever you are, matching you with therapists who understand and support you.

The post How Do I Know if I’m Drinking Too Much? appeared first on Talkspace.

Therapy is life-changing, offering positive emotional support and healthy coping skills to recover from addiction. Recovery takes patience and often comes with ups and downs, but it’s worth it in the long run. Treatment is a hard process, but not as hard as living with addiction day in and day out. No matter where you are in your recovery journey, therapy can help you improve your mental health and become the best, addiction-free version of yourself.

What is Addiction?

Addiction is a brain disorder where an individual relies upon a substance or behavior to an extent that it has negative consequences, according to the American Psychological Association. Addiction involves engaging in harmful behavior with high frequency and in large quantities, making it incredibly difficult to stop despite the repercussions. There are many types of addiction, from substance abuse to video games to gambling. 

Talkspace Senior Clinical Manager and therapist Kate Rosenblatt, MA, LPC, LMHC says, “It’s important to remember that addictions are not about willpower or lack thereof. Rather, it’s often our biochemistry gone awry, and that’s what can be contributing to these behaviors.” Addiction is not a personal fault but an illness that takes over the brain, causing us to depend on something harmful.

Because addiction is a mental illness, it is extremely hard to curb the addiction from persisting without professional help. Thankfully, there are many treatments and therapies available to support your recovery. 

Common types of substance addiction

Substance abuse impacts the lives of millions of Americans every year and can have life-threatening consequences. Approximately 19.3 million people have a substance abuse disorder and 14.5 million have an alcohol use disorder, according to the Substance Abuse and Mental Health Services Administration. The most common substances abused include alcohol, tobacco, opioids, cocaine, marijuana, and prescription drugs.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-V), which psychologists use to diagnose mental illnesses, includes several addictive disorders. These include several substance addictions, which should be taken seriously. 

Stressful times can trigger an increased dependence on substances. COVID-19 is an example of one event causing individuals to increase their reliance on addiction. We want to numb ourselves when dealing with challenging situations or emotions, even if this will harm us long-term.

“We’ve unfortunately seen a rise in substance use disorders since the pandemic, as people tried to cope with the emotional stress and uncertainty that they felt during COVID-19,” Rosenblatt says. “As of only June 2020, the CDC reported a 13% increase in substance use in American adults, in both increased frequency and quantity of the substance.”

Whether COVID or other life factors are causing your stress, substance abuse must be treated to keep you and those around you safe. Consider taking an addiction screening, like this one, and reaching out for support from a mental health professional.

Other prevalent types of addiction

Addiction is certainly not limited to substance abuse, as there are many behaviors we can come to rely too heavily on, leading to negative repercussions. Addictions can include an unhealthy dependence on shopping, video games, exercise, sex, food, gambling, or social media. If you find you can’t go without one of these and must engage in the behavior with high frequency, you may be dealing with an addiction.

Extremes of anything in life are unhealthy, which is why addiction is dangerous. Some of these addictions may be less life-threatening than substance abuse, but they should still be taken just as seriously. Social media or video gaming can be fun in moderation, but when we can’t function without engaging in the behavior, this has become an addiction likely harming your life in many ways.

Just like substance abuse, treatments for these types of addiction are available and effective. Do not hesitate to reach out for support if you’re struggling with any type of addiction.

How Does Therapy Help Treat Addiction?

As an intense mental illness, addiction is best treated with therapy. It may be tempting to say you can handle the problem on your own, but recovery from an addiction is challenging and complicated, so healing is most effective with professional support. 

“Therapy can be extremely helpful in recovering from our addictions [because] we can learn about the psychoeducation of addiction,” says Rosenblatt. This includes “what’s going on in our brains, and making meaning or understanding out of this painful experience.” 

Rosenblatt adds that those struggling with addiction are often in deep pain, which is why working on yourself in therapy is so helpful. “When we’re in pain, it can feel helpful to work with a therapist who can validate where you are, and how you’re feeling, and ultimately help you move closer to where you want to be in life,” says Rosenblatt.

Therapy teaches us skills to better cope with life’s challenges and provides a safe place to explore the emotional pain we’ve suffered. This is foundational to understanding and then working through your addiction towards recovery.

Types of Therapy Used to Treat Addiction 

Therapy is one of the most effective methods proven to treat addiction. Different types of therapy work well for each individual and their addiction, so it’s important to find the best fit for you. 

Cognitive behavioral therapy (CBT) is one method commonly used to treat addiction, according to Rosenblatt. “CBT looks at how our thoughts impact our feelings, which impact our behaviors,” she says. “So if we want to change our behavior specific to addiction, we can work with a CBT therapist to identify thoughts or feelings that drive these addictive behaviors, and learn skills to break this thoughts – feelings – actions chain of events.”

CBT is often done through individual therapy, where you frequently meet with a therapist one-on-one. Group therapy is also a great option for those struggling with addiction. Facilitated by a therapist or experienced leader, group therapy brings together several people working to recover from similar addictions. It is a supportive environment that works well on its own or in tandem with individual therapy. 

Both individual and group therapy are proven to be effective treatment methods in helping to heal addiction. Consult a doctor or therapist to find what type of therapy works best for you.

The benefits of group therapy in treating addiction

Individual therapy is a great way to work through your problems one-on-one, but group therapy allows us to connect with others going through similar struggles and provides a sense of camaraderie. Groups like Alcoholics Anonymous and Narcotics Anonymous have helped millions of people recover from addiction. Dealing with addiction can feel lonely and isolating, so group therapy provides a support system of those who get what you’re going through.

“It can feel very connecting and de-stigmatizing to meet other people who are struggling with similar issues,” says Rosenblatt. “Often, group therapy can help us validate how we’re feeling, and we can find hope in hearing other’s stories of recovery.”

There are many ways to get involved with a group, such as through a therapist facilitating group therapy or through non-professional support groups like AA and NA. Also, now with the prevalence of online therapy, there are even more ways to get involved with a group from the comfort of your home.

It may seem daunting to start group therapy, but it can be rejuvenating to speak with and learn from people also on the path towards healing from addiction. It can be powerful to connect with others like you and cathartic to open up about your addiction. It’s a different experience from individual therapy, so it’s also worth exploring to see if it benefits your healing process.

When to Seek Professional Help

It’s best for someone dealing with addiction to seek out professional help as early as possible, according to Rosenblatt. It can be scary to ask for help due to the stigma often associated with addiction, but the earlier you start treatment the more you can avoid serious health complications and negative life impacts, such as job loss or relationship fallouts. Early intervention makes it easier to learn to replace the addiction with healthy coping skills.

“Remember, there are times in our lives where we experience lots of stress, or anxiety, or depression, or pain, especially after this past year with COVID,” Rosenblatt says. “If we can allow ourselves to name that ‘oh yes, this is anxiety,’ or ‘this is addiction,’ then we begin accepting where we are, a conduit for health behavior change and recovery.”
Are you ready to start your recovery journey? Talkspace offers the resources you need to get started today, with affordable, online therapy available in just a few clicks. Remember, addiction is fully treatable and you are deserving of recovery.

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Cannabis is widely celebrated for its medicinal and recreational qualities — it’s known to relax, uplift, and even help with pain and trauma. However, there’s one aspect that tends to be overlooked. As the third most commonly used substance in the U.S., after alcohol and tobacco, cannabis can leave a percentage of its users dependent on the drug. This dependency is known as cannabis use disorder;here’s what you need to know about it.

Is Cannabis Addictive? 

It might be surprising to learn there’s such a thing as cannabis depency. Often in TV and film, stoners are portrayed with a gentle or comical nature. Compared to withdrawal from harder drugs like heroin, which can cause illness, seizures, or even death, the idea of being addicted to cannabis can easily be downplayed. 

But according to the National Institute on Drug Abuse, 30% of people who use cannabis have some degree of usage disorder. There’s controversy around using the word addiction when it comes to cannabis, which is why problematic use of cannabis is often, though not always, considered a disorder or dependency. When studies examine substance use, they consider dependence as what makes someone addicted, though it’s possible to be dependent on a substance without being addicted. Physically this can manifest in withdrawal symptoms when not using the substance. 

Who’s Affected?

According to a 2020 study on cannabis use disorder, 9% of all cannabis users will experience addiction to the substance, nearly a fifth of whom began using as adolescents. As more states opt to legalize cannabis, these numbers can begin to increase. 

As with other substances, the reason a person becomes dependent on cannabis can result from numerous factors. Some of these can include sociodemographic, environmental, genetic, and maybe even neurocognitive factors.

What to Know About Cannabis Dependency

A 2018 review that thoroughly examined cannabis addiction, defined it as a “chronically relapsing disorder” marked by compulsive drug seeking and intake, loss of control in limiting intake, and the emergence of a negative emotional state when access to a drug is prevented. 

It found that withdrawal symptoms for chronic cannabis users could include: 

• Irritability
• Anger or aggression
• Nervousness or anxiety
• Sleep difficulty
• Decreased appetite or weight loss
• Restlessness
• Depressed mood. 

Additionally, physical withdrawal symptoms can cause significant discomfort including shakiness or tremors, sweating, fever, chills, and headaches.

Dependence on cannabis starts when brain chemistry changes as a result of the substance use, altering the levels and sensitivity of its naturally occurring endocannabinoid neurotransmitters. This disorder is considered an addiction when the user’s life is negatively impacted as a result of their usage. 

The 2020 study on cannabis use disorder outlined several points to define it as a “problematic pattern of usage that leads to clinically significant impairment or distress, as manifested by at least two of the following, occurring over a 12-month period:”    

• Cannabis is often taken in larger amounts or over a longer period than was intended.    
• An unwavering desire or unsuccessful efforts to cut down or control cannabis use.    
• A significant amount of time spent in doing what’s necessary to obtain cannabis, use cannabis, or recover from its effects.    
• Craving, or a strong desire or urge to use cannabis.    
• Recurrent cannabis use that results in failure to fulfill day-to-day obligations at work, school, or home.    
• Continued cannabis use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of cannabis.    
• Important social, occupational, or recreational activities are given up or reduced because of cannabis use.
• Recurrent cannabis use in situations in which it is physically hazardous.    
• Cannabis use continues despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by cannabis. 
• Tolerance, as defined by either: a need for markedly increased cannabis to achieve intoxication or desired effect or a markedly diminished effect with continued use of the same amount of the substance.    
• Withdrawal, as manifested by either (1) the characteristic withdrawal syndrome for cannabis or (2) cannabis is taken to relieve or avoid withdrawal symptoms.

What are Treatment Options for Cannabis Dependence?

Currently, there are no FDA-approved medications that help with cannabis use disorder. However, according to the World Health Organization, there are various therapies available to help tackle these challenges. These include:

• Cognitive Behavioral Therapy. CBT helps the user identify and address problematic patterns and behaviours as a way to strengthen self-control, and in turn, work on drug use.
• Motivational Enhancement Therapy. Motivational enhancement therapy is an approach which aims to inspire quick and internally motivated change, as opposed to doing a step-based program. 
• Contingency Management. A behavioural therapy in which patients are “reinforced” or rewarded for positive behavioural changes. 

For teenagers struggling with cannabis dependency, family interventions were considered more effective than individual counselling in helping with abstaining from usage. 

This winter might feel like an ideal time to overindulge in cannabis, but it’s important to be aware of the effect it has on your life and on those around you. Cannabis use disorder or dependency can impact a high percentage of users, based on a variety of factors, such as how you were raised, the environment, and even genetics. For those struggling with cannabis use disorder, there are various therapy treatments available to help target those challenges. 

With Talkspace online therapy, you can speak to a licensed therapist today from the comfort of your home. 

The post Is Cannabis Addictive? What to Know about Cannabis Use Disorder appeared first on Talkspace.

By August of 2015, Marco had lost contact with all friends and family members, and had lost his career. He smoked more, which added to his depression. He stayed at home, arranging Party and Play (PnP) encounters with other users, where they would consume the drug in order to enhance sexual activity. 

He states, simply: “I knew I wanted to die.” 

What is “Harm Reduction”?

When we hear the words “addiction” and “recovery,” many of us think of the 12-step model, founded in 1935 as Alcoholics Anonymous. For decades, however, there have been alternative roads to recovery, and the “harm reduction” model is one such approach that has gained in popularity and effectiveness in recent years.

While Harm Reduction may be used for all substances, this article focuses on the outpatient group program of “Crystal Clear,” at Mt. Sinai Hospital’s Addiction Institute in New York City, which works to treat crystal meth addiction, primarily among the gay male population. 

Harm reduction is defined by a focus on reducing the negative effects of substance use, rather than trying to prevent or stop the usage itself, incorporating a spectrum of strategies that includes safer use and managed use. Advocates of harm reduction support the goal of people working towards abstinence, but recognize that, for many, this process takes time and that setbacks do not amount to defeat.

Harm reduction isn’t a new idea. While the term can be dated back to 1987, the idea of minimizing the harm caused by substance use disorder can be traced to the 1920s. The International Harm Reduction Association (IHRA) was founded in 1996.

Principles of harm reduction

The IHRA lists eight principles of harm reduction. The first two of these principles embody the non-judgmental approach toward managing addiction:

1. Accepts for better or worse, that licit and illicit drug use is part of our world, and chooses to work to minimize its harmful effects rather than simply ignore or condemn them

2. Understands drug use as a complex, multi-faceted phenomenon that encompasses a continuum of behaviors from severe use to total abstinence, and acknowledges that some ways of using drugs are clearly safer than others

A common misconception about Harm Reduction is that it condones or encourages drug use. The eighth and final principle combats this fallacy:

8. Does not attempt to minimize or ignore the real and tragic harm and danger that can be associated with illicit drug use.

For a full list of the Association’s eight principles of Harm Reduction check out the National Harm Reduction Coalition’s website.

Crystal Clear

Joseph Ruggiero, PhD, is a clinical psychologist who has worked in the field of addiction for twenty years. He is the co-founder and director of the Crystal Clear program, the only program of its type for crystal meth addiction in New York City.

With crystal meth use among the gay male population reaching epidemic proportions at the start of the 21st century, Dr. Ruggiero saw the need for a program that specifically addressed the needs of gay men and crystal meth addiction.

Dr. Ruggiero does not believe that the harm reduction and 12-step approaches are in conflict. In fact, many of the program’s clients take advantage of both models. But he does believe that the harm reduction approach is more integrated, in that it can include tools such as psychotherapy, skills building, pharmaceutical interventions, support groups that encourage “cross talk,” and a deeper understanding of the complex of drug use in people’s lives. 

Ruggiero states that “harm reduction is about working on goals that the client wants to work on and not making assumptions, and meeting people ‘where they’re at.’” He describes an approach in which relapse, ambivalence, and struggle are often a part of that process. 

Making choices

Kaitlyn Murphy, M.A., MHC-LP, co-leads the Crystal Clear program, and runs many of its outpatient groups. She sees the program as one which helps people make choices by looking at their motivations, while also giving them tools to achieve their goals.

During the COVID-19 shutdown, Murphy’s groups have been meeting virtually. With consistency in membership, over time, comes trust in one another. Members talk of shame and trauma and shared experiences. 

Murphy believes that success in the program is about someone reaching their goals and living a life that is happier or has meaning. It is about living a life within the person’s own values — which generally goes hand in hand with using less, and often leads to abstinence. 

Both clinicians talk about the amazing transformations they see in their clients.

This is one of those transformations.

Marco’s Journey

Marco was in a spiraling depression, with suicidal thoughts. He didn’t take his HIV medication for a year, and he weighed 90 pounds, down from his normal 145. That summer, his brother had made two attempts to check in on Marco at his apartment. During his third attempt, in October, he came with the police. The next morning, Marco admitted himself into the psych ward at Bellevue Hospital. No one close to him had ever suspected that drugs were involved with his deep depression; he had been adamantly “anti-drug” until the age of 45. 

He was at Bellevue for 10 days, for suicidal ideation. Upon his release from Bellevue, Marco revealed his drug use to his brother.

But that didn’t stop him. As soon as he left the hospital, his drug use returned, and with a vengeance. In January 2016, Marco was out of a job and behind on his rent when a marshall came to evict him from his apartment.

In the summer of 2016, Marco’s use escalated further, from smoking to “slamming.”

“Slamming” is a term for injecting a substance into a vein, via a syringe and needle. Not all who smoke crystal meth slam. But those who do see it as the surest way to addiction, psychosis, and a precipitous decline in health, welfare, and social interaction. 

Seeking help

In August 2017, Marco began attending Crystal Clear group therapy, along with occasional 12-step meetings. During his first year, he continued to relapse. But, slowly and surely, the tools he learned through the program began to take hold and, with an enormous amount of strength, courage, and commitment, Marco was able to turn his life around. In August 2020 he “graduated” from the harm reduction program after two full years of sobriety. He is now studying to become a drug addiction counselor.

Marco’s success story is remarkable, given his rapidly escalating drug addiction, many relapses, and descent into physical and emotional darkness.

Understanding relapse is, in fact, a vital part of getting sober, according to Marco. The key to his recovery has been in recognizing the triggers and using the tools he has learned.

When he first came to Crystal Clear, he didn’t believe he could do it. After months of sobriety, he began to believe, for the first time, that he could stop using totally. Through the Crystal Clear program, Marco was at first able to process his recovery in a more responsible way, in a non-judgmental atmosphere, until he finally reached his ultimate goal of complete abstinence.

Recovery Takes Commitment

Marco’s journey to recovery may be an extreme one, but it is not at all unique. Some in his support group continue to struggle with addiction, after many years of use. Many have periodic relapses. Others have left the group and continue to use. And still, others in the group have died from drug-related causes. 

Despite the differences among the group members, there are striking commonalities: the progression from casual use to addiction; feelings of shame, trauma, and alienation that both fuel, and are the result of, addiction, as well as the sexual validation that comes from the drug’s euphoric and invincible powers.

The Harm Reduction model has helped group members make use of the tools they learn through the program. One member, Raphael,* states that, for him, the term “relapse” can be daunting, whereas a “slip” means that he needs to keep coming to group and committing, perhaps in a different way, to the tools he has learned. 

Members are discovering the deeper meanings behind their use. And that helps them to use more responsibly, less frequently, or to achieve abstinence.

Through open, honest communication, often by revealing wounds that have been locked up in shame for their entire lives, members find that recovery is possible, in an atmosphere of non-judgmental support and encouragement.

*Clients interviewed for this article used pseudonyms in order to speak freely. 

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Researchers have known for a while that LGBTQ people as a whole experience increased substance abuse. But until recently, a lack of research on the full spectrum of LGBTQ identities has left us without detailed information on how this affects different members of the community.

Megan S. Schuler is one of the researchers trying to change that. An Associate Policy Researcher at the RAND Corporation, a non-profit research institute, Schuler says that a mixture of biphobia, trauma from sexual violence, and poverty can significantly increase bi women’s risk. Analyzing survey data, Schuler and her co-researcher, Rebecca L. Collins, found that both lesbian and bisexual women use substances more than heterosexual women — and bisexual women are at the highest risk.

“There’s a full spectrum of substance use: substance use, and then substance use disorder,” says Schuler. Bi women are more likely to experience everything from marijuana use, which may be casual or occasional (40% of bi women use marijuana, as opposed to 26.1% of lesbian women and 10.3% of heterosexual women), to alcohol use disorder (12.5% of bisexual women, compared to 7.7% of lesbian women and 3.9% of heterosexual women) and opiod misuse (including 12.6% of bisexual women, 7.0% of lesbian women, and 3.5% of heterosexual women).

To understand why bisexual women experience these unique risks, it’s important to look at the specific kinds of discrimination we face, and the links between addiction and trauma. By understanding the root causes of the harm bi women experience, we can build more resilience for ourselves and our communities.

There Are Health Differences Across LGBTQ Identities

All women and LGBTQ+ people experience the negative effects of gendered discrimination. Yet different members of the LGBTQ community experience different kinds of violence and risk, due to both our unique LGBTQ identities and our intersecting experiences of racism, poverty, disability, immigration, and more.

Until recently, however, most public attention and research dollars went to studying the queer community as a whole, rather than paying attention to the individual needs of different orientations or identities. “Many have just compared sexual minority individuals as a group to heterosexual individauls as a group,” says Schuler. This often resulted in public health approaches that center the struggles and needs of privileged white, cis men.

In contrast, many LGBTQ people experience violence from multiple systems of oppression. Due to intense discrimination and a lack of resources, trans people — especially trans women of color — are at particularly high risk of depression, anxiety, and self-harm. Similarly, LGBTQ people of color and poor LGBTQ people, especially Black trans women, face a particularly high risk of both interpersonal and police violence. Undocumented LGBTQ individuals are also at high risk of victimization.

To truly liberate ourselves as LGBTQ people, we need to follow the lead of community activists, and pay attention to how our struggles intersect. By understanding how we differ, as well as how we’re united, we can center and uplift the most vulnerable members of our communities.

Bi women are particularly vulnerable

Bisexual women bear a particularly heavy trauma burden, a major factor in substance use. Discrimination increases our risk of sexual violence, poverty, and substance use. Each of these factors then exacerbate the others, creating a vicious cycle of vulnerability for many bi women.

While thirty-five percent of heterosexual women, and 44% of lesbian women, experience sexual or intimate partner violence — already disturbingly high rates — a full 61% of bi women are victimized. Some studies place this number at 75%. Additionally, 37.3% of bisexual men experience intimate-partner violence, a much higher rate than heterosexual men (29%) and gay men (26%).

Relatedly, 30% of bi women (both cis and trans), and of trans people of all sexual orientations live in poverty. This is substantially more than poverty rates for cis gay men (12%) and cis lesbian women (18%), which are identical to the poverty rates of their straight counterparts.

When it comes to substance abuse, trauma and poverty combine with discrimination to lead to queer women’s overall higher risk of substance use, with bi women experiencing the highest risk of all. Due to overlapping forms of discrimination, queer women of color have especially high substance use rates, according to Schuler. There is, unfortunately, still a gaping hole in the research on bi trans women’s substance abuse risk, but we do have evidence that trans women’s particularly high rates of sexual and partner violence victimization translate to increased mental health risk in general.

Because of this combination of discrimination, sexual trauma, substance use, and poverty, around 30% of women in the justice system are lesbian or bisexual, in contrast to 3.4% of the general U.S. population.

Discrimination and Trauma Hurt Bi Women’s Wellbeing

All of the kinds of trauma bi women experience are related. To understand and break this cycle, let’s look at some specific ways bisexual women experience discrimination and violence — specifically, biphobia.

Discrimination starts early

Studies have shown that peer discrimination and harassment against young LGBTQ people can increase our risk of future substance abuse. Bullying is particularly associated with bisexual young people’s increased alcohol use. “I think that trauma and rejection starting with early childhood and adolescence is really important,” says Schuler.

Young LGBTQ women report feeling higher levels of stigma than their male counterparts. This is particularly true for bisexual women, who often lack role models who are out and bi. Young bi women are surrounded by stereotypes that bisexuality isn’t “real,” that bi people are “actually” straight or gay and simply confused, or that bi people should “choose a side.”

“The sexual identity development process potentially is more prolonged or confusing” for bi women, says Schuler. “Bisexuality is not presented as a valid option.”

Biphobia exists in the LGBTQ community, too

Biphobia isn’t just present in mainstream society. It plagues the LGBTQ community, too. “Bisexual indvidiuals report a lot of stereotypes from sexual minority and non-minority partners,” says Schuler. “There’s potentially rejection on both sides.”

This includes stereotypes that bisexual people aren’t sufficiently committed to LGBTQ identity or the struggle for equality, or the pernicious idea that bisexual people are “prone to cheating” because they are attracted to more than one gender. Likely because of these in-group pressures, bisexual women who report being more out about their sexuality actually experience greater alcohol and drug use, especially if they feel greater discrimination.

Sexual trauma can lead to substance use

Trauma, such as sexual and intimate partner violence, leads to greater risk of substance abuse. Since bisexual women experience such high rates of sexual violence, it makes sense that, unfortunately, we may use substances to cope with that trauma.

“A lot of people report subsequently using substances to cope in part from constantly experiencing victimization,” says Schuler. This victimization partly stems from stereotypes of bi women as hypersexual. “Our standards of women regarding sexuality are clearly different than men. I think that’s the real magnifying factor,” says Schuler.

Researchers like Nicole Johnson, at Lehigh University’s Resistance Lab, back up this explanation, arguing that because bi women are stereotyped as indiscriminately sexual, our partners may use our bi identity as an excuse to coerce or control us. Bi women may turn to substances to help us cope with the resulting trauma. “Some substance use may be self-medication for psychological distress,” concurs Schuler.

Unfortunately, substance use can make us even more vulnerable to assault. This doesn’t mean, however, that our trauma is at all our fault. It means we need greater support to heal.

We Can Keep Each Other Safe

While these statistics sound grim, there are many reasons to remain hopeful. Those reasons are within each of us. They are our own resilience, our own capacity for love and healing, and our own solidarity and community building.

In order for bi women to truly access safety and healing, we need both societal change — better healthcare, access to safe housing, workplace protections — and community spaces where we can build ourselves up, and be free from discrimination and abuse. This is work we can do by ourselves and together, every single day. We can seek out groups, both online and IRL, specifically for bisexual people and bisexual women to come together and build our own power and healing. We can also care for ourselves by connecting with LGBTQ and bi-affirming mental health resources, especially if we’ve experienced some kind of sexual trauma or are worried about our substance use.

Above all, we can remember that whoever we are, whatever we do — whether we use drugs or not, are bi or queer, are survivors of sexual violence, are trans or poor or sex workers — we all deserve lives and communities free of violence and full of the love and material support we need to thrive.

The post Why Are Bisexual Women At A Higher Risk Of Substance Abuse? appeared first on Talkspace.

Oh, the holidays. We’d all probably like to imagine ourselves sitting around a table spread sumptuously with fixings, decorative gourds and horns of plenty glinting sweetly in the candle glow — giving thanks for all that we have — and relaxing into the peace and togetherness of being with our friends and family. But that’s not the case for all or, maybe even most of us.

To say that the holidays can be tough is an understatement. Even if you and your angry uncle aren’t at each other’s throats over politics, Thanksgiving can be challenging. And for many of us, it’s the food and alcohol that’s triggering.

Whether you’ve struggled with addiction in the past, have a difficult relationship with food, or have a family member who doesn’t understand and challenges you on these issues — to everyone’s discomfort — the holidays can be a huge source of stress.

Managing Holiday Eating Triggers

Dealing with emotional triggers during the holidays poses unique challenges for everyone, but if you have struggled with disordered eating, you might be triggered by the rituals around that happens over the holiday season, and particularly the emphasis on overindulgence. Amy Cirbus, PhD, LMHC, and Talkspace Clinical Marketing Manager, gives four pointers to manage holiday overeating triggers, including:

• Incorporate mindful eating
  Listen to your physical hunger cues and eat only until you’re full. Enjoy what you choose to eat!
• Identify your support system
  Find one person you can connect with and want to spend time with. This can reduce your stress and ensure you enjoy your time — and remember, avoid toxic people when possible.
• Remember self-care
  Be okay with declining a holiday invite. Don’t beat yourself up for a bad food day — being too hard on yourself can actually lead to more bad food days. Be kind to yourself.
• Come up with a plan
  To navigate stress that leads to unhealthy food choices, it’s important to have a gameplan. You might ask what the menu is ahead of time so you have the opportunity to bring a dish you’re comfortable eating.

These pointers are just suggestions, but if you find yourself feeling stressed or triggered by food or alcohol this Thanksgiving, try one of these tips and see if it helps. Having some strategies going in may decrease the stress and leave you better able to enjoy the holiday.

8 Steps to Reduce Holiday Stress

Managing the stress that triggers your unhealthy food and alcohol choices can actually help stop overeating before it starts. Cirbus explains that, “The holiday season is packed full with activities, expectations and stress. For a lot of people, keeping food and alcohol intake on point and in check can feel impossible. There are steps to take in order to reduce the intensity of the season.”

Below are eight ways to reduce your holiday stress so that you can better connect with the spirit of the holiday, gratitude.

1. Acknowledge your triggers
   Identifying triggers is essential to managing and avoiding them when possible.
2. Have a plan
   Having a basic strategy reduces anticipatory anxiety and leaves you room to breathe.
3. Set time limits
   The later it gets the less likely that common sense reigns. Decide on an appropriate exit plan.
4. Identify a safe person
   Having that one person in a room full of stress can make all the difference.
5. Avoid heading out hungry
   Before a festive dinner or holiday social, eat something you feel good about. It’s the difference between feeling fulfilled versus restricted.
6. Schedule in self-care
   This time of year can suck the energy right out of you. Rejuvenate your body and mind, and make sure that you have extra time just for you — it can make all the difference.
7. Cut yourself some slack
   When you have a bad day, let it go. Start fresh tomorrow.
8. Talk about it
   You’re not alone and there’s no shame in sharing your struggles with those who care about you. Talking about how tough this time of year is helps reduce the pressure.

While everyone’s mental health journey is different, we’ll continue to share tips and strategies for navigating the holidays.

From all of us at Talkspace, Happy Thanksgiving!

The post A Therapist’s Guide to Managing Holiday Triggers appeared first on Talkspace.

Everyone has their comfort object. For some it’s a childhood stuffed animal or blanket; for others it’s an essential oil diffuser or white-noise machine, a favorite book or meaningful piece of jewelry. But for many people, the thing that they turn to in times of stress, anxiety, or sadness is food.

Emotional eating — also known as compulsive eating or overeating — is not uncommon. Thirty-eight percent of adults surveyed by the American Psychological Association reported that they had overeaten at least once in a given month due to stress, and nearly half reported that these behaviors happen at least once a week. Much like drugs or alcohol, food can become an addiction.

When we find ourselves emotionally eating, it’s a destructive catch-22: sometimes we may be overeating because we can’t find control in other areas of our lives, but when we overeat we feel out of control because of the eating. Let’s explore why we start, and where it comes from.

Emotional Eating Is Different From Binge Eating

First, let’s start with an important distinction that often results in confusion. Binge eating, or binge eating disorder, often gets conflated with emotional eating or other kinds of compulsive eating. The criteria for binge eating includes eating until you are uncomfortably full and also experience a loss of control around your ability to eat (meaning you feel like you can’t stop yourself from doing it).

There is some overlap between binge eating and emotional eating — binge eating is often propelled by unconscious emotions — but emotional eating doesn’t have to involve a loss of control or eating until uncomfortably full. In the case of emotional eating, the emotion — whether sadness, loneliness, or unhappiness — is often felt at the forefront of the behavior.

Why Is Food So Comforting?

Our bodies are programmed to eat when we’re hungry and stop when we’re full, but for emotional eaters, the programming gets overwritten by a different code that tells them to eat when they’re not hungry (and, sometimes, when they’re already full). This can lead to physical health complications like dangerous spikes in blood sugar, high blood pressure, and increased risk of heart disease and diabetes, not to mention emotional harm like guilt or shame. The problem is that the impulse to keep eating once you’re full, can feel compulsive in the same way that smokers reach for a cigarette or exercise addicts turn to the gym. Dr. Michael Mantell, a clinical psychologist based in California, told Greatist that, like any other compulsion, the reasons why people overeat are simply “ways of dealing with negative emotions that are not rational or healthy.”

This can be filling a void due to the loss of a job or a loved one, or trying to replace one kind of pain (for example, anxiety or depression, which is correlated with emotional eating) with a different kind of pain (fullness). Food can also have positive emotional associations with pleasant memories: maybe eating a candy bar reminds you of crisp, autumn nights trick-or-treating with your siblings. Maybe ice cream reminds you of the time your mom took care of you when you had your tonsils removed. Whatever memories food summons is what draws us to it, even when we know that it might not be the healthiest coping mechanism out there.

4 Ways to Avoid Emotional Eating

Many people who are drawn to eating for comfort may feel that they need to give their hands or mouth something to do if they want to refrain from turning to chips or popcorn or cookies. Fortunately, there are many ways we can occupy our minds — and hands and mouths — when the urge to eat compulsively strikes.

1. The first thing that you want to do is to check in with yourself when you feel compelled to munch. Ask yourself if you’re actually hungry right now, or if you’re eating for a different reason. If it’s the latter, ask yourself if you’re feeling okay. Are you sad? Lonely? Angry? Anxious? It may be the emotion that’s really hungry, and not your stomach.
2. Second, try to remove the temptation, either by physically taking yourself away from the food that beckons or by removing the food from immediate reach. If you know that you tend to overeat ice cream when you’re sad, limit the amount of ice cream in your freezer. It doesn’t mean you have to stop buying ice cream altogether; start by buying it less often or, if necessary, buy smaller quantities so you’re not able to consume as much as you normally would.
3. Third, busy yourself with something else. Grab a notepad and start journaling. Take a walk or spend 10-15 minutes doing some yoga or meditating. Call or text a friend — anything that will distract you from your comfort object, food.
4. Finally, it may help to find a therapist you click with, who can help you explore your feelings. If you carefully examine the feelings that drive you to eat, you’ll feel better in more ways than one.

And if you’re ready to start exploring these emotions, get matched with an online therapist today.

The post What is the Root of Emotional Eating? appeared first on Talkspace.

Let me explain. If I have a bad day at work or catch a wave of social anxiety at a group event, like a wedding, my first instinct is to make that feeling go away. What is one of the quickest ways to do that? Alcohol…which is why I have to be careful. More times than not, my desire to drink alcohol is directly tied to my desire to escape uncomfortable feelings. Red flag!

Similarly, I used to get so overwhelmed with making “healthy” food and lifestyle choices that I would go overboard on how much food restricted and how much I would exercise. It felt like an “all or nothing” game to me. Much like my relationship with alcohol, it was the motive behind restricting food and exercising a lot that became an issue.

Since I often say I have an addictive personality, I decided to consult the experts to get their thoughts on this concept.

Here are the four burning questions I asked:

1. Is there such a thing as an addictive personality?

According to Rachel O’Neill, Ph.D. LPCC-S, and Ohio-based Talkspace therapist, there is no official mental health diagnosis to support an addictive personality.

However, she confirmed that there are certain personality traits that are associated with addictive tendencies. As she shared, “Individuals who tend to feel over-connected to certain activities or processes — at the expense of doing other things in their life — may demonstrate traits of an addictive personality.”

I resonate a great deal with the word “over-connected” because while I never felt like I was putting myself in danger with my drinking or disordered eating habits, I was definitely aware that I cared a lot about having a glass of wine to “take the edge off” or eating as few calories a day as possible.

2. Where does addiction come from?

There is no one reason someone develops an addiction or is more prone to addiction than someone else. “Addiction is a complex interplay of both biological (genetic) predispositions and environmental influences (like stress and trauma),” explained O’Neill. With that being said, O’Neill noted that the age of first substance abuse and family history of addiction are two contributors to keep an eye out for.

While I have spent a lot of time trying to piece together why it feels like I have a tendency towards addiction, I have come to accept that not everything needs an explanation — not even for myself.

3. Can practicing mindfulness help?

There is a growing body of research that supports mindfulness-based interventions for addiction treatment, and it has been shown that mindfulness is especially effective at helping with cravings and substance misuse. As O’Neill explained, people who have tendencies of an addictive personality may struggle with emotional regulation skills.

“[Practicing mindfulness] can help with awareness of the present moment and allow an individual to feel greater control over some of their impulses,” shared O’Neill.

I can attest to the fact that practicing mindfulness has been a game-changer to helping me deal with my emotions in a healthier way. Instead of living life so reactively — thanks to mindfulness — it’s easier for me to tune into my body and honor what my true needs are underneath the superficial desire to numb. It has not been an overnight thing, but I have stayed committed to meditating every day.

4. What are the best resources to heal an addictive pattern?

Here are Dr. O’Neil’s three go-to recommendations when it comes to learning how to heal your pain instead of numbing out on substances or other addictions:

• A Liberated Mind by Steven Hayes: This newly-released book by the creator of Acceptance and Commitment Therapy explores ways to help folks focus on living in the moment and letting go of past pain.
• Twelve Steps and Twelve Traditions: This is a good text for those interested in exploring the AA approach of recovery from addiction.
• The Addicted Mind Podcast: This podcast provides reliable information about addiction treatment and research.

While it is unclear to me whether I was ever “addicted” to alcohol, exercise, food restriction, working, stress, perfectionism, social media, or praise, (and countless other things).I felt imprisoned by forces outside myself, but it didn’t change the fact that I wanted to find alternative solutions to deal with my emotions.

I don’t think you need to be labeled “addicted” to something in order to seek out professional help. After all, you are in charge of your own healing journey.

The post 4 Questions About Addictive Personalities Answered appeared first on Talkspace.

After a while, however, I began to notice one of my classmates hit the gym for more time on the treadmill either before or after these long practices. At first, I wished I somehow had that same motivation, the same drive. Soon though I realized how problematic the behavior could be.

Today, as we celebrate National Women’s Health and Fitness Day, it’s important to recognize that exercise can actually become unhealthy.

When Does Exercise Cross a Line?

There are so many benefits of exercise. Exercise can decrease your risk of stroke, high blood pressure, type 2 diabetes, depression, and anxiety. Researchers have, however, helped to identify when habitual exercise turns psychologically addictive, as well as how to determine when the addictive behaviors return to normal. Four phases for problematic exercise have been established to help us to understand when exercise crosses a line.

Phase one: recreational exercise

Exercise is considered recreational when someone finds what they’re doing both pleasurable and rewarding. They’re not forcing themselves to the gym, but rather taking a nice hike outside when they feel like it. The motivation is simply health and fitness; they are able to stop this exercise if they want.

Phase two: at-risk exercise

Don’t get us wrong, exercise can be a great way to stay both physically and mentally healthy. Exercise has great mood-altering effects, including providing increases in self-esteem, and decreases in depression and anxiety.

For example, going on a run can help you clear your mind, taking an exercise class can give you a sense of community, and exercise in general releases endorphins. However, experiencing these benefits can put you at a slightly higher risk of becoming psychologically “addicted” to exercise. Talkspace Therapist Cynthia Catchings, LCSW-S, CFPT shares that, “When we exercise, our body releases endorphins and dopamine from the brain. The need for these might create an addiction in the same way unhealthy drugs do.” This phase isn’t necessarily problematic, but it’s important to be mindful for when it does cross a line into addiction.

Phase three: problematic exercise

Examples of problematic exercise behaviors include planning an entire day around exercise, continuing to exercise with an injury (or, for example, switching from weight-lifting from running after an ankle injury), withdrawing from group activity to train individually, or showing any withdrawal symptoms.

Withdrawal symptoms including: guilt, shame, anxiety, restlessness, depression, anger, tension, pain, loss of appetite, and headaches. These are all signs exercise has become problematic. Extreme and unwarranted negative feelings about not being able to exercise can also be an indicator that the exercise has become problematic. If you or someone you care about is displaying uncharacteristic behavior or missing events they normally wouldn’t, because of their training commitments, this might indicate they have an issue with problematic exercise.

Phase four: exercise addiction

When avoiding withdrawal symptoms becomes one’s primary motivator, rather than the pleasurable benefits exercise once provided, there is strong evidence of an addiction at hand. Organizing your life around how often you exercise can be all consuming and create a vicious cycle. Someone in phase four might neglect other responsibilities and social relationships as a consequence of this addiction.

You can have a healthier relationship with exercise. And it doesn’t have to be something you quit cold turkey — it’s about balance. Catchings lists, as indicators it might be time to seek out help from an in-person or online therapist, these signs of exercise addiction:

• Unhealthy interest in exercise, like going to the gym more than twice a day or spending hours at a time exercising when the person is not an athlete
• Anger or depression when not able to exercise
• The need to increase amounts of exercise
• Personal and relationship challenges because of obsession with exercise
• Social withdrawal and decreased involvement in other activities
• The need to work out even when sick or hurt

Tips to Combat Exercise Addiction

It may take more time for some than others to regain a healthy relationship with exercise. Catchings suggests starting with, “A combination of therapy and soft exercise like yoga or walking, as well as meditation and mindfulness activities.”

Below, she shares how to work toward a healthy routine:

• Work with a fitness instructor that monitors your activity and progress
• Exercise with a friend
• Keep an exercise log
• Research healthy exercise activities
• Consult with a professional if you feel your daily habits or routines are affecting your personal life or those you love

We’ll never tell you to quit exercising. Physical health is extremely important — and has many physical, and emotional benefits — but just be sure it’s not taking a toll on other aspects of your wellbeing.

The post When Does Exercise Become an Addiction? appeared first on Talkspace.

Lowers Productivity

If you’re restricting your binge behaviors to your personal time, you’re not in too much risk. But if you’re swiping up, up, and up during your nine-to-five, expect your work stress to increase. A full 34 percent of employees like their jobs less when they’re distracted. Multi-tasking directly impacts your work: Juggling your Twitter obsession with your weekly report increases job pressure and frustration.
Your performance may also suffer: researchers found that distracted employees were slightly more brusque and wrote slightly shorter emails, because they were rushing through those tasks. Speed-working may introduce errors, too. One study found that distracted workers were twice as likely to screw up. And all that job stress can make you sick.
For the sake of your health and your job, put down the phone.

Trains Brain To Crave Dopamine

Often, when we’re distracting ourselves, we’re really doing one thing: searching for our next dopamine hit. Whether we’re craving salty, fatty potato chips or another Facebook like or the thrill of a loot box, distractions are really a hunt for happiness.
But cheap thrills have big consequences. Dopamine makes us want more. Soon, you’re not just excited about new Instagram followers. You’re craving them, and you start dreaming of bigger and bigger numbers. It becomes a primary focus — at the expense of important physical must-haves, like exercise, healthy foods, and social interactions.
If you notice yourself stuck in a pleasure-reward pathway, it’s time to step away.

Hurts Physical Health

Not only are your brain’s reward pathways damaged by distractions, but your body can be damaged, too. How many times have you caught yourself lying on the couch, unmoving, as you head into hour six of your Orange Is the New Black marathon? Your body remembers. Some scientists believe sitting is as bad as smoking, and for good reason: the risks of cardiovascular disease, obesity, diabetes, deep-vein thrombosis and other nasty diseases all increase the longer you sit.
Binging your favorite shows can be delightfully distracting, but soon enough your body will protest. That goes double if you’re downing pint after pint of ice cream, which damages your body even more directly. At a minimum, shake up your sesh with some light exercise, or try sitting on a stability ball. Even better? Go out for a run — your body will thank you.

Impacts Your Brain Health, Too

Multitasking with your favorite distraction isn’t just bad in the corporate world. In addition to spiking the dopamine feedback loop, our brains get a thorough beating from the modern world. Spending too long scrolling can spike your cortisol, which increases stress, and adrenaline, which leads to a fight-or-flight reaction. The result? Fuzzy thinking and trouble concentrating.
This goes double if you’re trying to learn and distract yourself simultaneously. Studying for your stats exam while watching old episodes of The Office might seem like a phenomenal idea, but your professor might just disagree. Science says that multitasking makes it hard to absorb new information. Instead of storing itself in the hippocampus — where information is easy to retrieve — that essential knowledge goes to the striatum, which holds procedures and skills.
If you’re distracting yourself to get through a dull work or school task, try hard to focus. Otherwise, you might wind up wondering where all that information went.

Avoids The Real Problem

There’s another good reason to ditch the distractions: You’re covering up the real problems. Often, we turn to easy comforts, like video games, television, food or social media, so we can avoid feeling sad or anxious. You might feel better, but the problem still remains — and ignoring mental health concerns makes them harder to address in the future.
In order to overcome depression, anxiety, or other psychological issues we need to acknowledge their existence. And yes, that means putting down the phone. If you feel like you’re using distractions to avoid serious issues, talk to a mental health professional, who can help you get to the root causes.

The post When Do Fun Distractions Become Unhealthy? appeared first on Talkspace.