My Partner Is Alcoholic.  What Can I Do? 

Many problem drinkers are unable to admit to this problem. The cry for help may therefore come from someone close who suffers as a result. The cry often comes at a time when he or she is unable to cope any longer with the drinker. As such, the drinker may self-righteously feel they do not have a problem as they had been drinking like this for years. They may resist treatment and often blame others for their problems. Many marriages fail at this point. One spouse can no longer tolerate the alcohol and the alcoholic refuses to take responsibility. This makes treatment of alcoholics extremely difficult. 

It is important for people to understand the stages of recovery and that each stage carries challenges that some alcoholics will struggle for a long time to overcome. Five stages of recovery are discussed: precontemplation, contemplation, preparation, action and maintenance.¹
 
The Five Stages of Recovery
 
In the precontemplation stage, the alcohol problem has not yet been identified let alone accepted by the alcoholic. During this stage, their defences, most notably denial, are strong. They actively reject any notion of alcohol problems and show anger towards anyone suggesting a problem. They reject treatment and may rely on the support of their drinking buddies to affirm that they do not have a problem. 

In the contemplation stage, the alcoholic toys with and finally accepts that they have a problem with alcohol. This acceptance can be overwhelming, at times leading to depression and/or anxiety. These intense feelings must be expected and planned for as part of a treatment process.  

In the preparation stage, the alcoholic learns what treatment is necessary in order to recover. Depending on the severity, this can include detoxification, inpatient or outpatient counseling and marital and/or family therapy and possibly even prescription medications. 

The next stage, action, is when the treatment plan is implemented and activities are undertaken to address the alcoholism. The support of family and sober friends is crucial here as alcoholics learn to defend themselves, not from admitting alcoholism, but from being pulled back towards drinking by former drinking buddies. Also crucial at this stage is developing an understanding of one’s own family history that may have contributed to their drinking problems. 

The final stage involves relapse prevention and is referred to as maintenance. This stage is life-long. One of the best-known maintenance programs is Alcoholics Anonymous (AA). This program is based upon self-help, group model. Members meet regularly to manage the challenges of sobriety.
  (more…)

By William Shryer, LCSW, BCD

Clearly one of the most misunderstood disorders in the field of neuroscience is the diagnosis of “Obsessive-Compulsive Disorder.” It occurs from early childhood all the way throughout the life span.

It is actually a spectrum of disorders generally seen when one cannot get a particular thought out of their conscience mind. They may think they are contaminated, that something horrible will befall someone they love. They may think that they may utter something blasphemous. They may feel convinced that there is something about their body that is misshapen or looks ugly. They may look endlessly in mirrors and ask others of they notice the defect. They may avoid going out, certain that others will notice their defect. The public is generally unaware of the suffering that so many go through dealing with their “stuck thinking.”

Obsessive-Compulsive Disorder has more symptoms than just about any other diagnosis. From the better known symptoms such as those seen in the movie, “As Good as it Gets” with Jack Nicholson, where hand washing and certain rituals were present, to the lesser known symptoms such as “hoarding”, stuck thoughts, and many believe that even anorexia may be a symptom on this wide and unusual spectrum. Clearly one of the most disturbing for some is the, “distress of perceived ugliness,” known as Body Dysmorphic Disorder or BDD.

Click here for the rest of this article

By Katherine van Wormer, PhD, MSSW

Introduction
In 1980, in response to the veterans of the Vietnam War and the militancy of the antiwar movement, the American Psychiatric Association (APA) acknowledged the symptoms of Post Traumatic Stress Disorder (PTSD). The diagnosis of PTSD was then included in the DSM (Diagnostic and Statistical Manual of Mental Disorders). The feminist movement was influential in this development as well due to their advocacy for a diagnosis in recognition of the trauma of rape.

The DSM IV-R (2000) describes PTSD, in short, as the “re-experiencing of an extremely traumatic event that the person has experienced or witnessed, accompanied by symptoms of increased arousal (such as sleep disturbance, irritability, hypervigilance, difficulty concentrating) and by avoidance of stimuli associated with the trauma and numbing.”

Post Traumatic Stress Disorder Related to Combat
After the war in Vietnam was over, some 30 percent of Vietnam combat veterans suffered from PTSD; flashbacks to horrible near-death situations were common. A study conducted in 2003 involved 6,200 soldiers who had served in Iraq and Afghanistan several months before. Research was conducted by a team of social scientists at the Walter Reed Army Institute of Research.

Results showed that one in six of the veterans displayed symptoms of PTSD, major depression, or anxiety; 12 percent had symptoms of PTSD alone. (These figures are an underestimate as the study was done before the far more brutal urban combat efforts got underway.) The risk of developing trauma rose in proportion to the number of instances of combat in which the soldier had engaged.

According to a more recent Post-Deployment Health Reassessment, which is administered to all service members, 38 percent of regular soldiers and 31 percent of Marines report psychological symptoms. Among members of the National Guard, the figure rises to 49 percent. Those who had served repeated deployments were at extremely high risk of problems and the toll on their family members was great.

The exact rate of PTSD in women veterans is unknown. Studies conducted after the Gulf War  concluded that female service members were more likely than their male counterparts to develop PTSD. This is consistent with the 2 to 1 ratio of female to male PTSD sufferers in the general population.

Males with psychological symptoms from battle, however, are three times more likely to be given a diagnosis of PTSD than females, according to the Pentagon Task Force report.

One explanation for this may be cultural expectations that make it difficult for society and mental health providers to recognize women as combatants. Additionally, there is a tendency to diagnose women as having depression, anxiety and borderline personality disorder instead of combat-related PTSD.

For several reasons, the impact of the Iraq and Afghanistan wars is expected to be more severe than the impact of previous wars. (1) The experience of combat, engagement in gun battles, and handling the bodies of dead comrades is a constant in these wars, (2) the experience of killing people at close range is a frequent occurrence, (3) extended lengths of service with only short periods of rest and recuperation in between are taking a psychological toll on soldiers; and (3) many of the injuries in this war are to the brain.

[Click here to read the rest of this article on www.helpstartshere.org]

There are an estimated 11,000 new cases of spinal cord injury (SCI) in the United States per year. Over the last several years, SCI has primarily affected persons aged 16 – 30, 78 percent of whom are males; and predominately Caucasian (78 percent).

Almost half of the spinal injuries occur as a result of motor vehicle injury, second are falls, and the remainder come from acts of violence such as gun shot wounds or knife injuries as well as war related injury.

SCI is defined as, damage or trauma to the spinal cord that results in loss of sensory and motor function. An SCI can result in either a “complete injury” (a loss of all voluntary movement) or an “incomplete injury” (a partial loss of voluntary movement).

An SCI is classified utilizing a scale developed by the American Spinal Injury Association (ASIA) that uses a system to describe the level of injury. For example, a person with an ASIA A complete injury describes a person who has no voluntary movement or sensation below the level of injury.

Dealing with the Diagnosis

Spinal cord injury (SCI) is a devastating event that not only has physical but social and psychological ramifications for both the individual and the family. In one moment, a person’s world is monumentally changed forever with reverberations throughout the whole family system. The person who sustains an SCI is at high risk for many factors including: dependency, depression, drug addiction and, if married, divorce. They can also struggle with debilitating secondary medical complications and other factors such as the effects of perceived social discrimination, declining help and lack of social, family, and emotional support.

Family Implications

When something traumatic happens to one family member, the whole family feels the effects. Roles and responsibilities change. Marital strain occurs when one partner has to take on unfamiliar roles such as providing assistance with activities of daily living, financial responsibility and intimacy changes. This can put the person without the disability at high risk for depression.

Parents who have a young adult child that has an SCI will often reestablish the role or responsibility of parenting. If the person has left home, this may mean moving back in. This can affect self-esteem of the person with SCI and cause conflict with parents.

Interpersonal relationships are affected as well. Friends who may have had previous interests or activities they enjoyed doing together are now different. The person with SCI may withdraw or may feel embarrassed being seen post-injury. While having a young child sustain a spinal cord injury, brings a new dynamic to the entire family system and numerous challenges to the child who must face an SCI during times of dynamic growth and development. (more…)

Introduction

In recent years, medical advances have produced revolutionary treatments for people with HIV that slow the progression of the disease and prolong life. Unfortunately, various strains of the HIV virus are also evolving, becoming increasingly resistant to drug treatments, which may lead to the drugs or medication therapies failing. Genetic testing is now used for people with HIV to help identify drug-resistant HIV strains so that physicians can prescribe the most effective treatment options.

HIV (human immunodeficiency virus) is a disease that destroys or damages a type of white blood cell (CD4 T-cells) in the immune system and progressively decreases the body’s ability to fight infections and certain cancers. The virus causes AIDS (acquired immune deficiency syndrome).

People with AIDS have a significantly reduced number of healthy white blood cells, and therefore become more susceptible to life-threatening infections caused by microbes that rarely cause illness in healthy people.

Although there is no cure, treatment for HIV has advanced with highly active antiretroviral therapy (HAART), which suppresses the virus. However, HIV is constantly replicating and can mutate so that antiretroviral medications designed to treat a certain strain of virus are no longer effective.

Drug resistance is the most common reason why medication therapies fail. People with HIV may have several different strains of the virus, so determining the optimal treatment option becomes more difficult.

Types of Genetic Tests

Two types of genetic tests are available to determine if a resistant strain of HIV is present in a person using HAART: phenotype and genotype testing. Phenotype testing measures the amount of drug required to completely stop HIV replication in a blood sample. In contrast, genotype testing identifies the mutations in the genetic structure of the virus that have been linked with drug resistance.

Genetic analysis of HIV/AIDS helps researchers to better track the patterns of disease transmission, and to better understand how the virus affects the human body. No one test is sufficient for making treatment decisions.

People with HIV/AIDS work with a variety of professionals who diagnose and treat the disease and help manage the physical and mental health and social issues related to the disease. Social work professionals play an important role in the disease management team.

Social workers employed in community human services agencies, hospitals, and in private practice help people with HIV/AIDS to decide whether or not to have genetic testing and to understand the implications of test results. Additionally, social workers coordinate community services and help their clients address the life changes that often accompany a diagnosis of this life-threatening disease.

###
Source material:� HIV/AIDS: Understanding the Role of Genetics by Evelyn P. Tomaszewski, MSW, published in the NASW Specialty Practice Sections Health Connection, Spring 2005.

Related Articles:

• About HIV/AIDS
• HIV/AIDS Current Trends
• HIV/AIDS: Your Options
• HIV/AIDS: How Social Workers Help
• HIV/AIDS Tip Sheets
• Resources on HIV/AIDS
• HIV/AIDS Real Life Stories

Infertility is an experience that strikes at the very core of one’s life. Reproduction is considered the most basic of human needs, propelled by powerful biological and psychological drives. When the ability to reproduce is thwarted, a crisis ensues and impacts relationships with others, life goals, social roles, and sense of self. A host of emotions emerge in a somewhat predictable and repetitive process as one moves through medical diagnosis and treatment. Feelings of disbelief, anger, sadness, guilt, blame, anxiety and depression can be overwhelming and finding appropriate avenues to express these emotions is important.

For most people, in vitro fertilization (IVF) is not the first course of treatment for their infertility—it is the last, best option for having a child. It occurs after long months and sometimes years of treatment failure, often at tremendous emotional, physical and financial cost. Couples beginning IVF usually do so with the burden of grief and disappointment from infertility, and may feel depressed, angry, tired, and anxious. Although emotionally depleted, couples are attracted to a technology that offers hope where none may have existed. They find themselves drawn into new emotional turbulence of contrasting feelings of hope and despair, which seems to be generated in part by the experience of the technology itself.

The opportunities that IVF creates brings with it significant challenges. IVF is considered by patients to be the most stressful of all infertility treatments. Patients have rated the stress of undergoing IVF as more stressful than or almost as stressful as any other major life event, such as a death of a family member and separation and divorce. While general assumptions may be made about stress levels during IVF, the experience for infertility patients will be personal and unique—each patient will experience the stress differently based upon his or her own personality and life experiences.

The aspects of IVF that are perceived stressful to patients are multifaceted and affect all parts of their life: marital, social, physical, emotional, financial, and religious. Time is stressful, both in the time commitment to an intense treatment which leads to disruption in family, work, and social activities, and for some, in long waiting periods for treatment services. IVF stress impacts the marital relationship with an emotionally laden experience and, by removing the conjugal act of procreation, sexual intimacy is lost. Couples, also, are stretched financially paying for the high cost of IVF treatment with a relatively low probability of success. Dealing with the medical staff and with the side effects or potential complications of medical treatment has its own stress: hot flashes, headaches, mood fluctuations, shots, sonograms, future health concerns, and decision making about embryos and multiple pregnancies. Religious, social, and moral issues may also make IVF stressful, especially for those dealing with third party reproduction, when these values are in conflict with the choice of treatment.

The first treatment cycle has been found to be the most stressful for patients, with high levels of confusion, bewilderment, and anxiety. This may be due to inexperience with the process or possibly inadequate preparation of the patient by staff in terms of information and discussion of care. While experience seems to help the stress level in the next cycle, if it is unsuccessful the stress level rises again with the third cycle as the “stakes” have been raised. For many couples, IVF can feel like gambling where the stakes are high and the chance of success unknown. Like gamblers, some IVF patients may have unrealistically high expectations of success or feel compelled to try “just one more time” finding it difficult to end treatment after having already invested so much physically, emotionally, and financially to have a child.

Within a treatment cycle, patients view IVF as a series of stages which must be successfully completed before moving onto the next phase of treatment: monitoring, oocyte retrieval, fertilization, embryo transfer, waiting period, and pregnancy test stages. The level of stress, anxiety, and anticipation raises with each stage, peaking during the waiting period. Research has shown that in order of perceived stress for patients, waiting to hear the outcome of the embryo transfer is the most stressful, followed by waiting to hear whether fertilization had occurred, and then the egg retrieval stage. Patients are aware of the importance of these key phases in the IVF process and the uncertainty of the outcome is highly distressing.

Despite the stressful consequences of infertility and IVF, it is important to note that research has shown that the vast majority of patients are well adjusted. Further, there seems to be no long-term impact on the marital relationship and individual functioning. In fact, some research has shown that the crisis of infertility may actually improve marital communication and emotional intimacy. Couples may learn coping skills and communication patterns that provide life-long benefit.

IVF has the potential to be an emotionally, physically, and financially exhausting experience due to the “high stakes” and “end of the line” nature of this treatment. Thus, patients need to consider thoughtful preparation before beginning the process. If you are a patient about to begin a cycle, here are some tips to help get ready for IVF. (more…)

Excerpt from the U.S. Department of Eldercare Locator
Reviewed by NASW Office of Social Work Specialty Practice Staff

Today, family caregivers have� options� to choose from� when they need� assistance or respite.� And, highly trained and experienced social workers are available to help� caregivers sort through the range of available options.� � Below is a brief description of some� of the caregiving services commonly available.�

Adult Day Care

Adult Day Care Centers are designed to provide care and companionship for seniors who need assistance or supervision during the day. The program offers relief to family members or caregivers and allows them the freedom to go to work, handle personal business or just relax while knowing their relative is well cared for and safe.

The goals of these programs are to delay or prevent institutionalization by providing alternative care, to enhance self-esteem and to encourage socialization. There are two types of adult day care: Adult social day care provides social activities, meals, recreation, and some health-related services. Adult day health care offers more intensive health, therapeutic and social services for individuals with severe medical problems and those at risk of requiring nursing home care.

How Do Adult Day Care Centers Operate?

These centers are usually open during working hours and may stand alone or be located in senior centers, nursing facilities, churches or synagogues, hospitals, or schools. The staff may monitor medications, serve hot meals and snacks, perform physical or occupational therapy, and arrange social activities. They also may help to arrange transportation to and from the center itself.

Assisted Living

Assisted living facilities offer a residential alternative for older adults who may need help with dressing, bathing, eating, and toileting, but do not require the intensive medical and nursing care provided in nursing homes.

Assisted living facilities may be part of a retirement community, nursing home, senior housing complex, or may stand-alone. Licensing requirements for assisted living facilities vary by state and can be known by as many as 26 different names including: residential care, board and care, congregate care, and personal care.

Assistive Technology

Assistive technology is any service or tool that helps the elderly or disabled do the activities they have always done but must now do differently. These tools are also sometimes called “adaptive devices.”

Such technology may be something as simple as a walker to make moving around easier or an amplification device to make sounds easier to hear (for talking on the telephone or watching television, for instance). It could also include a magnifying glass that helps someone who has poor vision read the newspaper or a small motor scooter that makes it possible to travel over distances that are too far to walk. In short, anything that helps the elderly continue to participate in daily activities is considered assistive technology.
[Click here for the full article]

Note: All names have been changed to protect confidentiality.

By L.B. (LeslieBeth) Wish, Ed.D, MSS

Introduction

Sally had been a soldier’s wife for all twelve years of their marriage. She endured separations while her husband, Tom, was called to duty, and she toughed out raising twin boys alone. Sally said Tom loved her because, in his words, she was a “team player.” But ever since Sally learned that Tom was killed in a roadside bomb in Iraq, Sally doubts whether she can be a team of one. “I’m really not that strong,” Sally said. “It’s just a good act.”

When Rolanda was shot out of her helicopter, her husband Ray said he had no choice but to “pull himself together.” He had to focus on his job and raising his stepdaughter. “I only cry at night, and then only for a second or two. We were practically newlyweds. I don’t even know what I’ll be missing.”

“At least the kids are grown.” It was the first thing that came to Linda’s mind when she heard that her husband was killed in an ambush. But the relief was short—depression set in, and Linda felt “ashamed” for falling apart.

These stories provide a glimpse into the plight of many of the American families of downed warriors in Iraq. Each family’s grief is unique, but most share issues that are familiar to mental health professionals–adjustment, loss, grief, and anger.

Some families rely on friends, the Armed Forces community, and supportive family for help. But one of the issues that many (certainly not all) of these families also share is their reluctance to use the mental health services available to them.

Why? What makes providing counseling to these families so different from non-military families in mourning? And how can mental health professionals serve these families’ needs?

Let’s start with learning a little more about some of these families. Bear in mind, that there are many reactions to the loss of a family member and that not all families of downed warriors react the same. Yet, a constellation of beliefs, fears and adjustment issues does exist amongst many of these families, and it is important to become familiar with them.

Current Issues of Some American Military Families

At first, it seems that the most common issues of military families do not differ from the problems of families not in the military. People are people, as some say. After all, humans share common problems. Yet, military families often add elements to these issues that are unique to them.

Fear of Being “Found Out”

Many families worry about being seen in counselors’ halls and waiting rooms and about being judged and “found out.” They also worry about confidentiality. They believe that no matter what the organization, if it’s affiliated with the armed forces, it will keep records that could easily be shared with other branches and departments.

Non-military families may have similar feelings, but military families carry with them an extra dose of shame of being “found flawed.” They also say they “have had it” with the power of military and government rules. They long for privacy, and they have far higher doubts that their insurance can protect them.
[Click here to read the rest of this article...]

By Alyson Mischel, LCSW

Introduction

Historically, social workers are trained to work with the populations most in need of assistance. They practice in prisons, with drug users, the severely mentally ill, batterers and domestic violence victims, and with HIV positive clients. But, increasingly, social workers have private practices and treat people who can afford to pay for traditional 50 minute psychotherapy sessions. Regardless of the brand of social work practiced, or the population served, social workers can rely on concepts of media psychology to serve their clients.

Most everyone watches television, listens to the radio, or reads some form of printed press on a daily basis. Media is the 21st century’s glue – it’s what connects us and makes a Wall Street banker able to relate to a struggling waiter in Los Angeles. As a consumer who may communicate with a therapist online, or have a therapist use television and film as case studies, it’s important to understand the following basic concepts of media psychology and how they relate to psychotherapy.

Telemedicine

Telemedicine is the delivery of medical and/or psychological services at a distance with the use of technology like telephones or web-based systems. Treatment via telemedicine could involve� two medical professionals talking over the telephone in real time about a case and also the use of satellite equipment allowing a doctor in California to evaluate, diagnose, and treat, a patient in Brazil.

The focus of telemedicine is largely consultative, which is why there is a growing trend toward online, synchronous psychotherapy. Some psychotherapists offer online and telephone counseling services for marriage, depression, parenting, family, and grief issues.� The International Society for Mental Health Online,� the National Association of Social Workers and the American Psychological Association have issued statements about telephone counseling. Understanding how telemedicine works is essential for consumers since psychotherapists increasing use e-mail and the Internet to provide services.

Cinematherapy

Cinematherapy is the use of film as a metaphor to bring about positive growth in psychotherapy clients. Watching television and films may be a catalyst for healing and change. Movies� can be� “windows” to the unconscious in the same way that dreams and fantasies are. Watching films allows clients to become consciously aware, resulting in gained insight and emotional release. Cinematherapy works best in the tradition of Systems Theory and Cognitive Behavioral Therapy, which are the treatment modalities used by most social workers. Films may help clients become aware of their irrational beliefs and poor coping mechanisms. Cinematherapy is another tool like stories, myths, and fables, that psychotherapists use to treat their clients.

[Click here for the full article]

To read more from Alyson Mischel� visit www.alysonmischel.com

A positive, compassionate, and enthusiastic personality, Alyson Mischel brings a special brand of empathy to her psychotherapy and life coaching work. Alyson combines her education and clinical training with her own experiences, and has developed a common sense approach for addressing life’s challenges. Alyson is a lecturer at the USC School of Social Work, and serves as a consultant for UCLA’s Educational Leadership Program, a doctoral program of education. She was formerly a clinical supervisor for the Los Angeles County Department of Mental Health. Alyson has counseled hundreds of people in the areas of career, relationships, health, and finances. A graduate of Stanford University, the University of Southern California, and a licensed clinical social worker, Alyson has been studying and practicing since 1998.

Reviewed by NASW Office of Social Work Specialty Practice Staff

Introduction

Families plan and prepare for major life events: attending college, getting married, having a baby, and retiring at the end of a career. However, few plan for events� such as how we would want our health care delivered if we become very ill.

Or some people may be adamant about not going into a nursing home but they fail to plan for securing long-term care insurance, home modifications, or having someone to advocate for them if they cannot communicate. Rarely do we think that far head.

These are decisions that we all should be thinking about.� They should be documented so that our family members, health care providers, etc.� will know our wishes for our care.

In generations past, people who were terminally ill remained at home, dying quickly from infectious diseases or accidents. Today, with the deluge of new medicines and technologies, we have become a “death denying” society, in which death is an enemy that must be beaten at all costs. We focus on fighting death rather than preparing for its inevitability.

Who Needs Advance Care Planning?

Every adult can benefit from Advance Care Planning.� � Planning is particularly important for those who are terminally ill.� Research shows that people suffering from chronic illness also benefit from advance care planning. Even healthy people should consider their wishes for end-of-life care and discuss their decisions with family members or professionals, before a health care crisis occurs.

Because an accident or serious illness can happen suddenly, and at any time, thinking about this topic when you are capable of making decisions is important. Sharing these decisions with your family helps to ease their burden and reduce their uncertainty if they ever have to make health care decisions on your behalf.

What Are the Benefits of Advance Care Planning?

Studies funded by the Agency for Healthcare Research and Quality (AHRQ) have shown that people who talked with their family, physician, or others about their preferences for end-of-life care had less fear and anxiety, felt more in control of their own medical care, and believed their doctor had a better understanding of their wishes. Other potential benefits of advance care planning according to the National Institutes of Health include:

• Decreased personal worry
• Decreased feelings of helplessness and guilt for the family
• Decreased implementation of costly, specialized medical interventions
• Decreased overall health care costs

[Click here for the full article]